Organization
MANDAL'S CONSERVATIVE NEPHROLOGY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANIL KUMAR MANDAL M.D. (OWNER)
(904) 305-1234
Entity
Organization
Contact information
Practice address
800 ZEAGLER DR, PALATKA, FL 32177-3883
(904) 824-8158
Mailing address
800 ZEAGLER DR, PALATKA, FL 32177-3883
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME0074439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255413500
—
FL
Enumeration date
03/17/2016
Last updated
03/17/2016
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