Provider Demographics
NPI:1427132307
Name:MANGARELLI, CAREN (MD)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:MANGARELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6110
Mailing Address - Fax:
Practice Address - Street 1:467 W DEMING PL STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2898
Practice Address - Country:US
Practice Address - Phone:312-227-6450
Practice Address - Fax:312-227-9441
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-01143208000000X
IL0361000442080B0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2023276Medicare ID - Type Unspecified
H33781Medicare ID - Type Unspecified
NC89135C3Medicare ID - Type Unspecified