Basic Information
| Provider Information | |||||||||
| NPI: | 1760777627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANSALIS | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | PANAGIOTIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 740020 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303740020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127339730 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7521 SE 15TH ST | ||||||||
| Address2: | |||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731105425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054538004 | ||||||||
| FaxNumber: | 4055614857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A116924 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 33366 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.