Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 15289 | ND |
N | 111NI0900X | Internist | 15289 | ND |
N | 207RC0200X | Critical Care Medicine | 15289 | ND |
Y | 207RP1001X | Pulmonary Disease | 15289 | ND |
NPI | 1033559620 |
---|---|
Provider Name | Antranik Mangardich |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 11/07/2019 |