Individual
JONATHAN A MANDELBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5255 E STOP 11 RD STE 450, INDIANAPOLIS, IN 46237-6342
(317) 865-4800
(317) 865-4806
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01033791A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100003568
RR MEDICARE
IN
05
—
100129080A
—
IN
Enumeration date
02/15/2006
Last updated
02/27/2023
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