Provider Demographics
NPI:1457580680
Name:MANGLA, ASHVARYA (MD)
Entity Type:Individual
Prefix:
First Name:ASHVARYA
Middle Name:
Last Name:MANGLA
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 1:233 E WACKER DR
Mailing Address - Street 2:APT 412
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5104
Mailing Address - Country:US
Mailing Address - Phone:773-575-4327
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PARWAY
Practice Address - Street 2:3-KELLOGG, DIVISION OF CARDIOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-8771
Practice Address - Fax:312-942-5829
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129310207RC0000X, 207RI0011X, 207RC0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist