Provider Demographics
NPI:1326026519
Name:MANN, MICHAEL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 630786
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-0786
Mailing Address - Country:US
Mailing Address - Phone:713-266-5225
Mailing Address - Fax:713-266-5335
Practice Address - Street 1:2500 FONDREN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2313
Practice Address - Country:US
Practice Address - Phone:713-266-5225
Practice Address - Fax:713-266-5335
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9842207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B6296Medicare PIN
H22817Medicare UPIN
TX8B6296Medicare ID - Type Unspecified