Provider Demographics
NPI:1336237312
Name:MANDEL, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:MANDEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5150 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 167
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5474
Mailing Address - Country:US
Mailing Address - Phone:414-224-7686
Mailing Address - Fax:414-224-7685
Practice Address - Street 1:5150 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 167
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5474
Practice Address - Country:US
Practice Address - Phone:414-224-7686
Practice Address - Fax:414-224-7685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI23817207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30592500Medicaid
WIB54795Medicare UPIN