Provider Demographics
NPI:1750870374
Name:DR THOMAS E MANDAT MD
Entity type:Organization
Organization Name:DR THOMAS E MANDAT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESCALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-235-8484
Mailing Address - Street 1:4758 RIDGE RD STE 161
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3327
Mailing Address - Country:US
Mailing Address - Phone:440-235-8484
Mailing Address - Fax:440-235-8484
Practice Address - Street 1:5592 BROADVIEW RD STE 103
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44134
Practice Address - Country:US
Practice Address - Phone:216-741-5200
Practice Address - Fax:216-741-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty