Provider Demographics
NPI:1851426621
Name:MANESTAR, LUISA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:T
Last Name:MANESTAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1645 S MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2908
Mailing Address - Country:US
Mailing Address - Phone:931-484-7531
Mailing Address - Fax:931-456-9515
Practice Address - Street 1:1645 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2908
Practice Address - Country:US
Practice Address - Phone:931-484-7531
Practice Address - Fax:931-456-9515
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-09-19
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Provider Licenses
StateLicense IDTaxonomies
TN48768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN48768OtherTN STATE MEDICAL LICENSE
TN4330620OtherBLUE CROSS BLUE SHIELD
TN455420558OtherTRICARE
TN48768OtherTN STATE MEDICAL LICENSE