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Individual
MR. WILLIAM THOMAS MANGAN JR.
Active
Individual
MR. WILLIAM THOMAS MANGAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101011930
MI
208D00000X
General Practice Physician
5101011930
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C36097
PTAN
MI
01
—
5101011930
LICENSE NUMBER
MI
Enumeration date
08/09/2005
Last updated
07/22/2016
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