Individual
KEVIN DALE MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DRIVE SPC 5856, FCVC 3RD FLOOR, RECEPTION B, ANN ARBOR, MI 48109-5856
(734) 936-5850
(734) 647-4285
Mailing address
1500 E MEDICAL CENTER DRIVE, 5346 CVC, ANN ARBOR, MI 48109-5867
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
4351044158
MI
Other
Enumeration date
04/25/2019
Last updated
04/25/2019
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