Provider Demographics
NPI:1659528263
Name:MANGOLD, KARL JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:JOSEPH
Last Name:MANGOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2825 STOCKYARD RD
Mailing Address - Street 2:SUITE J-1
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1503
Mailing Address - Country:US
Mailing Address - Phone:406-543-5333
Mailing Address - Fax:406-543-5621
Practice Address - Street 1:2825 STOCKYARD RD
Practice Address - Street 2:SUITE J-1
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1503
Practice Address - Country:US
Practice Address - Phone:406-543-5333
Practice Address - Fax:406-543-5621
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000298622Medicaid
MT6492890001Medicare NSC