Individual
EDMUNDO R MANDAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
36000 EUCLID AVE, WILLOUGHBY, OH 44094
(440) 953-6203
(440) 953-6202
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35044596M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0532767
—
OH
Enumeration date
03/29/2006
Last updated
07/15/2011
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