Individual
MICHAEL MANDRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4306
(719) 584-4861
Mailing address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4306
(719) 584-4861
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DR.0058185
CO
390200000X
Student in an Organized Health Care Education/Training Program
'RS2014-0418
NM
Other
Enumeration date
04/02/2014
Last updated
06/30/2017
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