Individual
DR. GIRISH C MANGALICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1623 FORD AVE, WYANDOTTE, MI 48192-2303
(734) 284-2600
(734) 284-2666
Mailing address
1623 FORD AVE, WYANDOTTE, MI 48192-2303
(734) 284-2600
(734) 284-2666
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301034377
MI
2084N0400X
Neurology Physician
Primary
4301034377
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130H222940
BC BS OF MICHIGAN
MN
05
—
3095760
—
MI
Enumeration date
08/09/2005
Last updated
01/21/2021
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