Provider Demographics
NPI:1649233214
Name:ARIAS, JOHN MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MANUEL
Last Name:ARIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:MANUEL
Other - Last Name:ARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1100
Mailing Address - Fax:952-942-3361
Practice Address - Street 1:9010 SADDLEBACK RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4740
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:952-942-3361
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM94722085R0202X
UT182009-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3810010512Medicaid
KY000000548183OtherANTHEM-KCR
OH2822897Medicaid
KY7100025880Medicaid
VAP00403946OtherMEDICARE RAILROAD
KY3427946000OtherPASSPORT ADVANTAGE
PA2016383OtherHIGHMARK BLUE CROSS/BLUE SHIELD
KY50017692OtherPASSPORT-KCR
KY91715OtherSIHO-KCR
PA102079853Medicaid
VA1649233214Medicaid
OHAR7375381Medicare PIN
KY3323284Medicare PIN
VA1649233214Medicaid
KY7100025880Medicaid
KY533006Medicare PIN
KY00533006Medicare PIN
KY593614Medicare PIN
KY3427946000OtherPASSPORT ADVANTAGE
VAP00403946OtherMEDICARE RAILROAD