| Doctor Name: | DR. GIRISH C MANGALICK |
| NPI Number: | 1225039522 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 4301034377 |
| Business Practice Address: | 1848 Biddle St Ste 101 Wyandotte, MI - 481924064 |
| Business Phone Number: | 7342842600 |
| Business Fax Number: | 7342842666 |
| Mailing Address: | 1848 Biddle St, Ste 101 WYANDOTTE |
| State: | MI |
| Postal Code: | 481924064 |
| Phone Number: | 7342842600 |
| Fax Number: | 7342842666 |
| NPI Enumeration Date: | 08/09/2005 |
| NPI Last Update Date: | 01/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/22/2006 |
| NPI Reactivation Date: | 05/11/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 4301034377 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |