Provider Demographics
NPI:1760588024
Name:MANI, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:180 WEIDMAN ROAD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:636-207-0277
Mailing Address - Fax:636-207-0221
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 250C
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-567-9199
Practice Address - Fax:314-432-1524
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO100216207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3944V19475OtherHCUSA
MOF92834Medicare UPIN
MO3944V19475OtherHCUSA