Provider Demographics
NPI:1114970571
Name:MANN, TODD BRADLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:BRADLEY
Last Name:MANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 N MERIDIAN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5378
Mailing Address - Country:US
Mailing Address - Phone:317-847-1558
Mailing Address - Fax:877-476-7125
Practice Address - Street 1:9011 N MERIDIAN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5378
Practice Address - Country:US
Practice Address - Phone:317-847-1558
Practice Address - Fax:877-476-7125
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000849213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200156430AMedicaid
U66973Medicare UPIN
INM400075376Medicare PIN
IL560750011Medicare PIN
IN480024402Medicare PIN