| Organization Name: | MANGOLD CENTER FOR FAMILY HEALTH AND WELLNESS |
| NPI Number: | 1649405564 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL N MANGOLD (PRESIDENT/OWNER) |
| Mailing Address: | 120 N Main St #120 West Bend |
| State: | WI US |
| Postal Code: | 530953376 |
| Phone Number: | 2623388100 |
| Fax Number: | 2622929747 |
| NPI Enumeration Date: | 05/20/2009 |
| NPI Last Update Date: | 09/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 32859 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |