Individual
TERRY JAY MANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4007 N HIGH SCHOOL RD, INDIANAPOLIS, IN 46254-2712
(317) 299-2664
(317) 299-2665
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
(317) 621-7584
(317) 957-2705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000682
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000752860
ANTHEM BCBS
IN
05
—
100073840
—
IN
01
—
P01424415
RAIL ROAD PTAN
IN
Enumeration date
08/15/2006
Last updated
04/14/2015
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