Provider Demographics
NPI:1093919995
Name:MANNING, MICHAEL WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:MANNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 S 900 E STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7003
Mailing Address - Country:US
Mailing Address - Phone:435-688-1152
Mailing Address - Fax:435-359-5119
Practice Address - Street 1:736 S 900 E STE 202
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7003
Practice Address - Country:US
Practice Address - Phone:435-688-1152
Practice Address - Fax:435-359-5119
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10441479-1204207X00000X
AZ005959207X00000X
WI60207X00000X
CA20A10882207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE408ZMedicare PIN
ALH430Medicare PIN
ALD564Medicare PIN