Provider Demographics
NPI:1376540385
Name:THUSAY, MANISH M (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:M
Last Name:THUSAY
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-693-0711
Mailing Address - Fax:
Practice Address - Street 1:2751 BAY PARK DR
Practice Address - Street 2:202
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4921
Practice Address - Country:US
Practice Address - Phone:419-693-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082131T208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2373373Medicaid
OHTH4098312Medicare PIN
H34278Medicare UPIN