Individual
DR. MICHAEL NORBERT MANGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 N MAIN ST, #120, WEST BEND, WI 53095-3376
(262) 338-8100
(262) 338-0405
Mailing address
120 N MAIN ST, #120, WEST BEND, WI 53095-3376
(262) 338-8100
(262) 338-0405
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
32859
WI
207Q00000X
Family Medicine Physician
Primary
32859-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000054100
MEDICARE, WPS, FQHC
WI
05
—
31843700
—
WI
01
—
521833
MEDICARE FQHC
WI
Enumeration date
07/21/2006
Last updated
09/02/2011
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