Provider Demographics
NPI:1407882384
Name:MANSKY, DAVID W (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MANSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:1127 W STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-7754
Practice Address - Country:US
Practice Address - Phone:269-945-2222
Practice Address - Fax:269-948-2223
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901001735213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3108483Medicaid
MI4856351410OtherBCBS
MI3108483OtherMOLINA
MI0M38770Medicare ID - Type Unspecified
MI3108483Medicaid