Provider Demographics
NPI:1881792794
Name:MANDAT, THOMAS EMIL (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EMIL
Last Name:MANDAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:EMIL
Other - Last Name:MANDAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10423 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141
Mailing Address - Country:US
Mailing Address - Phone:440-717-0533
Mailing Address - Fax:
Practice Address - Street 1:5592 BROADVIEW RD STE 103
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1677
Practice Address - Country:US
Practice Address - Phone:216-741-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0726843Medicaid
OHMA0672553Medicare ID - Type Unspecified
E65488Medicare UPIN