Provider Demographics
NPI:1609085612
Name:MCMANUS, MICHAEL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:720 S VAN BUREN ST
Mailing Address - Street 2:STE 301
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3538
Mailing Address - Country:US
Mailing Address - Phone:920-433-9400
Mailing Address - Fax:920-433-9409
Practice Address - Street 1:720 S VAN BUREN ST
Practice Address - Street 2:STE 301
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3538
Practice Address - Country:US
Practice Address - Phone:920-433-9400
Practice Address - Fax:920-433-9409
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI62831-20208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology