Provider Demographics
NPI:1780687830
Name:MANI, VENK (MD)
Entity Type:Individual
Prefix:DR
First Name:VENK
Middle Name:
Last Name:MANI
Suffix:
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 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2850
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:127 CRESTVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2850
Practice Address - Country:US
Practice Address - Phone:615-446-5121
Practice Address - Fax:615-446-1357
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8802207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3009590Medicaid
220029593OtherRAILROAD MEDICARE PIN
TN3158242OtherBLUE CROSS BLUE SHIELD TN
A97388Medicare UPIN
TN3009590Medicaid