Provider Demographics
NPI:1295872414
Name:MANDELL, WILLIAM JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:MANDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MISSION HILL WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2672
Mailing Address - Country:US
Mailing Address - Phone:719-488-8631
Mailing Address - Fax:
Practice Address - Street 1:6615 DELMONICO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1809
Practice Address - Country:US
Practice Address - Phone:719-590-9494
Practice Address - Fax:719-594-9761
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE47768Medicare UPIN
CO360638Medicare PIN