Provider Demographics
NPI:1104844935
Name:MANNSFELD, CHRISTIAN P (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:P
Last Name:MANNSFELD
Suffix:
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 1:8038 DOUGLAS RANCH DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6157
Mailing Address - Country:US
Mailing Address - Phone:916-872-4320
Mailing Address - Fax:
Practice Address - Street 1:11111 WILCREST GREEN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4813
Practice Address - Country:US
Practice Address - Phone:800-893-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115277207P00000X
CAG88465207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY315763OtherBSWY
IL036-115277OtherMEDICAL LICENSE NUMBER
IL036-115277OtherMEDICAL LICENSE NUMBER
WYW21726Medicare PIN