Provider Demographics
NPI:1639219421
Name:HOWARD S MANGURTEN MDSC
Entity Type:Organization
Organization Name:HOWARD S MANGURTEN MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:SHELDON
Authorized Official - Last Name:MANGURTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-884-8420
Mailing Address - Street 1:990 GRAND CANYON PARKWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-884-8420
Mailing Address - Fax:847-884-0198
Practice Address - Street 1:990 GRAND CANYON PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-884-8420
Practice Address - Fax:847-884-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628148OtherBCBS
1003990870OtherNPI
IL31603504OtherBCBS
1417055765OtherNPI
1417055765OtherNPI
1003990870OtherNPI
ILK37592Medicare PIN