Provider Demographics
NPI:1689627937
Name:MANTHEI, UWE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:UWE
Middle Name:
Last Name:MANTHEI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2742
Mailing Address - Country:US
Mailing Address - Phone:520-322-8361
Mailing Address - Fax:520-322-8462
Practice Address - Street 1:2902 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2742
Practice Address - Country:US
Practice Address - Phone:520-322-8361
Practice Address - Fax:520-322-8462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18457207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ293001Medicaid
AZ293001Medicaid
E04142Medicare UPIN