Organization
MANDELBAUM SURGICAL PC
Active
Other names
Indy Southside Surgical
Organization subpart
No
Provider details
NPI number
Authorized official
DENA L PETTY (MANAGER)
(317) 865-4800
Entity
Organization
Contact information
Practice address
5255 E STOP 11 RD, SUITE 450, INDIANAPOLIS, IN 46237-6340
(317) 856-4800
(317) 865-4806
Mailing address
5255 E STOP 11 RD, SUITE 450, INDIANAPOLIS, IN 46237-6340
(317) 856-4800
(317) 865-4806
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE6013
RR MEDICARE GROUP NUMBER
IN
Enumeration date
10/03/2006
Last updated
08/22/2020
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