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Individual
DR. MICHAEL E MANDIS
Active
Individual
DR. MICHAEL E MANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036112094
IL
207R00000X
Internal Medicine Physician
Primary
036112094
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112094
—
IL
05
—
036112094-3
—
IL
05
—
036112094-5
—
IL
01
—
06032146
BLUE CROSS ILLINOIS
IL
05
—
1821065764
—
MO
01
—
199147
BLUE SHIELD MO
MO
01
—
202790173
TRICARE
—
01
—
241366
GHP
—
01
—
701184
HEALTHLINK
—
01
—
7496677
AETNA
—
01
—
I23797
MERCY
—
01
—
P00265571
MEDICARE RAILROAD
—
Enumeration date
02/28/2006
Last updated
03/31/2020
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