Provider Demographics
NPI:1710919089
Name:MANN, DAVID E III (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MANN
Suffix:III
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38085207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00889597OtherRAILROAD MEDICARE
KY2442405000OtherPASSPORT ADVANTAGE PIN
KY50000742OtherPASSPORT PIN
KY64066905Medicaid
IN200447250AMedicaid
IN200447250FMedicaid
KY000000281778OtherANTHEM PIN
KY0368213Medicare ID - Type Unspecified
KY50000742OtherPASSPORT PIN
KY0558213Medicare ID - Type Unspecified
KYC18743Medicare UPIN
KY1271845Medicare ID - Type Unspecified
KY0558517Medicare ID - Type Unspecified
KY000000281778OtherANTHEM PIN
IN200447250FMedicaid
KY060071188Medicare PIN
KY0558607Medicare ID - Type Unspecified
KY0558416Medicare ID - Type Unspecified
IN200447250AMedicaid