Individual
SAT P MANGLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
14519 DETROIT AVE, LAKEWOOD, OH 44107-4316
(216) 521-4200
Mailing address
PO BOX 951101, CLEVELAND, OH 44193-0005
(440) 879-0081
(440) 879-0084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-001780
OH
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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