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Individual

ANNA M MANDALAKAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714

Taxonomy

Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
35-072385
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000183305
ANTHEM
OH
01
000000221080
UNISON
01
000000526102
ANTHEM
OH
01
2012575
BCMH
OH
05
2012575
OH
01
2352239
AETNA
OH
01
363801
WELLCARE
OH
Enumeration date
07/18/2006
Last updated
07/20/2011
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