Provider Demographics
NPI:1346217841
Name:MANNEY, LARRY G (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:G
Last Name:MANNEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17705 HUTCHINS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4145
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:952-401-8246
Practice Address - Street 1:17705 HUTCHINS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4145
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:952-401-8246
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-04-23
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Provider Licenses
StateLicense IDTaxonomies
MN42337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN649612100Medicaid
MN649612100Medicaid