Provider Demographics
NPI:1710929815
Name:MANN, NANCY REISMAN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:REISMAN
Last Name:MANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20180 W 12 MILE RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5412
Mailing Address - Country:US
Mailing Address - Phone:248-358-5959
Mailing Address - Fax:248-358-3299
Practice Address - Street 1:20180 W 12 MILE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5412
Practice Address - Country:US
Practice Address - Phone:248-358-5959
Practice Address - Fax:248-358-3299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055357208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB74688Medicare UPIN