Provider Demographics
NPI:1023644069
Name:MANDEL, JEFFREY HOWARD
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HOWARD
Last Name:MANDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 WESTRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2569
Mailing Address - Country:US
Mailing Address - Phone:952-920-2236
Mailing Address - Fax:612-626-4837
Practice Address - Street 1:6204 WESTRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2569
Practice Address - Country:US
Practice Address - Phone:952-920-2236
Practice Address - Fax:612-626-4837
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine