Provider Demographics
NPI:1598775702
Name:BOOKMAN, MANDELL TONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDELL
Middle Name:TONY
Last Name:BOOKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:818 W KING ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2116
Mailing Address - Country:US
Mailing Address - Phone:989-723-1529
Mailing Address - Fax:989-723-3507
Practice Address - Street 1:818 W KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2116
Practice Address - Country:US
Practice Address - Phone:989-723-1529
Practice Address - Fax:989-723-3507
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMB035646208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1802101Medicaid
MIB46739Medicare UPIN
MI0N53550Medicare PIN
MI1802101Medicaid