Provider Demographics
NPI:1235212713
Name:MANAHAN, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:MANAHAN
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 1:2615 EAST FRANKLIN AVE
Mailing Address - Street 2:UFP SMILEY'S CLINIC, UNIVERSITY OF MN PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:
Practice Address - Street 1:2615 EAST FRANKLIN AVE
Practice Address - Street 2:UFP SMILEY'S CLINIC, UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
299J2MAOtherBLUE CROSS BLUE SHIELD
894137OtherARAZ
HP18753OtherHEALTH PARTNERS
IA1938175Medicaid
01-09659OtherMEDICA CHOICE
114700OtherUCARE
1011064OtherPREFERRED ONE
WI34311400Medicaid
WI34311400Medicaid