Provider Demographics
NPI:1275959546
Name:LUDMIL MANOV MD PC
Entity Type:Organization
Organization Name:LUDMIL MANOV MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUDMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-642-2396
Mailing Address - Street 1:21 N 490 W
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2264
Mailing Address - Country:US
Mailing Address - Phone:801-642-2396
Mailing Address - Fax:801-642-2496
Practice Address - Street 1:21 N 490 W
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2264
Practice Address - Country:US
Practice Address - Phone:801-642-2396
Practice Address - Fax:801-642-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty