Individual
DR. SEBASTIAN R. MANGIAMELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 BEMIDJI AVE N, STE 6, BEMIDJI, MN 56601-4364
(218) 333-5694
(218) 444-4728
Mailing address
3801 BEMIDJI AVE N, STE 6, BEMIDJI, MN 56601-4364
(218) 333-5694
(218) 444-4728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
43323
MN
208100000X
Physical Medicine & Rehabilitation Physician
43323
MN
208D00000X
General Practice Physician
Primary
43323
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
640127900
—
MN
Enumeration date
04/27/2006
Last updated
08/12/2010
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