Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301072416 | MI |
Y | 111NI0900X | Internist | 4301072416 | MI |
NPI | 1003804766 |
---|---|
Provider Name | Ray Peter Mangulabnan |
First Address | Saginaw, MI 48609-9220 |
Second Address | Saginaw, MI 48603-2183 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 28/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010683841050 | COMM CHOICE CARE SOURCE (01) | |
0992071 | HEALTH PLUS OF MI (01) | |
0N48190 | WISCONSIN PHYS SERVICES (01) | |
1107304342 | BCBS OF MI (01) | |
4411167 | (05) | MI |
4411167 | MEDICAL SERVICES ADMIN (01) | |
7307374 | AETNA (01) | |
7307374 | AETNA US HEALTHCARE (01) | |
H58060 | (02) | |
MOLINA | QMXPR0027616 (01) | MI |
N48190001 | MEDICARE (01) | MI |
P25942F | BLUE CARE NETWORK (01) |