Provider Demographics
NPI:1427028455
Name:MENGEL, MARVIN (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:MENGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 VALLEY STREAM DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:FL
Mailing Address - Zip Code:32732-9229
Mailing Address - Country:US
Mailing Address - Phone:407-349-9993
Mailing Address - Fax:407-349-2705
Practice Address - Street 1:486 VALLEY STREAM DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:FL
Practice Address - Zip Code:32732-9229
Practice Address - Country:US
Practice Address - Phone:407-349-9993
Practice Address - Fax:407-349-2705
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19947207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052288100Medicaid
FL052288100Medicaid
FL48772Medicare ID - Type Unspecified