Provider Demographics
NPI:1790926632
Name:DAVE, MANEESH (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MANEESH
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MANEESH
Other - Middle Name:GURDARSHAN
Other - Last Name:DAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4150 V ST # 3500
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3751
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5202
Practice Address - Country:US
Practice Address - Phone:216-844-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090639207R00000X
OH35.124209207RG0100X
MN53306207RG0100X
CA160563207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHENROLLEDMedicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid
OHENROLLEDMedicaid
MN100000866Medicare PIN