Provider Demographics
NPI:1578635801
Name:EMMANUEL S MANUEL MD SC
Entity Type:Organization
Organization Name:EMMANUEL S MANUEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-643-4300
Mailing Address - Street 1:3201 S 16TH ST
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-643-4300
Mailing Address - Fax:414-384-4332
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:SUITE 1015
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-643-4300
Practice Address - Fax:414-384-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30299800Medicaid
WI30299800Medicaid