Provider Demographics
NPI:1467485391
Name:MANN, MORGAN EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:EARL
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:13819 HANSON BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7608
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-862-4490
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0109688OtherMEDICA #
MN1027375OtherPREFERRED ONE
MN261J8MAOtherBCBS OF MN
MN983108800Medicaid
MN7856409OtherAETNA INS
MNHP35998OtherHEALTHPARTNERS
MN6605849OtherMEDICA UC#
MN142814OtherUCARE MN#
MN1694603OtherAMERICA'S PPO
MNH19417Medicare UPIN
MN6605849OtherMEDICA UC#
MN080011496Medicare ID - Type UnspecifiedWPS MEDICARE - B