Provider Demographics
NPI:1376869651
Name:MANOUILOVA, LIDIA S (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:S
Last Name:MANOUILOVA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:929 N ST FRANCIS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5429
Practice Address - Fax:316-652-0340
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE25495207ZP0102X
KS0435112207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology