Provider Demographics
NPI:1508823329
Name:IMSEIS, MANUEL Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:Y
Last Name:IMSEIS
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 1:1419 MIMOSA ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3847
Mailing Address - Country:US
Mailing Address - Phone:504-340-2141
Mailing Address - Fax:504-340-2141
Practice Address - Street 1:1111 NEWTON ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2500
Practice Address - Country:US
Practice Address - Phone:504-364-4023
Practice Address - Fax:504-364-5606
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD-03687R208D00000X
LAMD3687R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB60688Medicare UPIN