Provider Demographics
NPI:1033171277
Name:MANN, AJAIB S SR (MD)
Entity Type:Individual
Prefix:MR
First Name:AJAIB
Middle Name:S
Last Name:MANN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 NORTH PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322
Mailing Address - Country:US
Mailing Address - Phone:954-474-0110
Mailing Address - Fax:954-424-9859
Practice Address - Street 1:1806 NORTH PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-474-0110
Practice Address - Fax:954-424-9859
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66835207R00000X
FLME 66835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF90809Medicare UPIN