Provider Demographics
NPI:1851326029
Name:MANDEL, LEE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MICHAEL
Last Name:MANDEL
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 1:4400 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3514
Mailing Address - Country:US
Mailing Address - Phone:954-983-1211
Mailing Address - Fax:
Practice Address - Street 1:4400 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3514
Practice Address - Country:US
Practice Address - Phone:954-983-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67643207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377302700Medicaid
FL5972804007OtherCIGNA
FL923524OtherFIRST HEALTH PPO
FL35001OtherVISTA OF SOUTH FLORIDA
FL809OtherTOTAL HEALTH CHOICE
FL2103463OtherAETNA
FL26580OtherNEIGHBORHOOD HEALTH
FL650799846OtherBEECHSTREET
FL27456OtherBLUE CROSS BLUE SHIELD
FL650799846OtherSOUTHCARE
FL7541OtherDIMENSIONS
FL27456TOtherMEDICARE
FL650799846OtherPREFERRED HEALTH NETWORK
FL0799828OtherGHI
FL27456TOtherMEDICARE
FLP00185085Medicare PIN