Provider Demographics
NPI:1568443380
Name:MCMANUS, KEIKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KEIKO
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3324
Mailing Address - Country:US
Mailing Address - Phone:210-614-5600
Mailing Address - Fax:210-614-8963
Practice Address - Street 1:7909 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3425
Practice Address - Country:US
Practice Address - Phone:210-614-5600
Practice Address - Fax:210-614-8963
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF9807207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128424202Medicaid
TXB24787Medicare UPIN