NPIMap

Organization Active NPI

Paul D Mandel MD SC

  • Ophthalmology Physician
  • Glendale, WI
National Provider Identifier
1366531865
Registry record updated Nov 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
23817 Issued in WI
Legal business name
PAUL D MANDEL MD SC
Practice address
5150 N Port Washington Rd
Suite 167
Glendale, WI 53217-5474
Phone
(414) 224-7686
Fax
(414) 224-7685
NPI assigned
Oct 12, 2006
Last updated
Nov 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Paul D Mandel, M.D.NPI 1336237312
Title
President/Owner
Phone
(414) 224-7686

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 23817 WI Primary

Addresses

Primary practice location

5150 N Port Washington Rd
Suite 167
Glendale, WI 53217-5474

Mailing address

5150 N Port Washington Rd
Suite 167
Glendale, WI 53217-5474
Phone (414) 224-7686

Other identifiers 1

IdentifierTypeStateIssuer
30592500MedicaidWI

National Provider Directory

National Provider Directory

Locations

5150 N Port Washington Rd
Ste 167
Glendale, WI 53217
Phone (414) 224-7686

2500 N Mayfair Rd
Ste 340
Wauwatosa, WI 53226
Phone (414) 224-7686

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226361600000",
    "number": "1366531865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD",
            "address_2": "SUITE 167",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175474",
            "telephone_number": "414-224-7686",
            "fax_number": "414-224-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD",
            "address_2": "SUITE 167",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175474",
            "telephone_number": "414-224-7686",
            "fax_number": "414-224-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL D MANDEL MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2008-11-11",
        "status": "A",
        "authorized_official_last_name": "MANDEL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "414-224-7686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "23817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30592500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.