| NPI | 1447798939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JAMES MANGO Owner 574-850-8408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: IN 01065998A) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-02-06 |