Basic Information
| Provider Information | |||||||||
| NPI: | 1235320367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR TERRY MANDEL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4007 N HIGH SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462542712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172992664 | ||||||||
| FaxNumber: | 3172992665 | ||||||||
| Practice Location | |||||||||
| Address1: | 4007 N HIGH SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462542712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172992664 | ||||||||
| FaxNumber: | 3172992665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | MANDEL | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3172992664 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02000682 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.