Provider Demographics
NPI:1609951771
Name:MANIVEL, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:MANIVEL
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 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 609
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-0622
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:760 MAYO BLDG
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-626-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29459207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0039975Medicaid
IA0515908Medicaid
MN1122550OtherMEDICA CHOICE NUMBER
MN2T224MAOtherBCBS MN NUMBER
MNHP22293OtherHEALTHPARTNERS NUMBER
MN1174545OtherMEDICA DUAL SOLUTIONS NO.
MN101364OtherUCARE NO.
WI32455000Medicaid
MN719205300Medicaid
MN1009228OtherPREFERRED ONE NUMBER
MN768244OtherAMERICA'S PPO NUMBER
MN768244OtherAMERICA'S PPO NUMBER
IA0515908Medicaid
MT0039975Medicaid