1639219421 NPI number — HOWARD S MANGURTEN MDSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639219421 NPI number — HOWARD S MANGURTEN MDSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD S MANGURTEN MDSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639219421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
990 GRAND CANYON PARKWAY
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-884-8420
Provider Business Mailing Address Fax Number:
847-884-0198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 GRAND CANYON PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-884-8420
Provider Business Practice Location Address Fax Number:
847-884-0198
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANGURTEN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
SHELDON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-884-8420

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01628148 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1003990870 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31603504 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1417055765 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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