Provider Demographics
NPI:1083606693
Name:MICHAEL MANKARIOUS MD PC
Entity Type:Organization
Organization Name:MICHAEL MANKARIOUS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NASR
Authorized Official - Last Name:MANKARIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-243-5601
Mailing Address - Street 1:638 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4742
Mailing Address - Country:US
Mailing Address - Phone:563-243-5601
Mailing Address - Fax:563-243-5637
Practice Address - Street 1:638 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4742
Practice Address - Country:US
Practice Address - Phone:563-243-5601
Practice Address - Fax:563-243-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA53221OtherWELLMARK BC/BS
IA0134759Medicaid
IA53221Medicare PIN