Provider Demographics
NPI:1881844538
Name:MENNINGER, MICHAEL CHARLES (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:MENNINGER
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 LEXINGTON BLVD
Mailing Address - Street 2:BUILDING 300, SUITE 149
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-5015
Mailing Address - Country:US
Mailing Address - Phone:361-776-5582
Mailing Address - Fax:
Practice Address - Street 1:1451 LEXINGTON BLVD
Practice Address - Street 2:BUILDING 300, SUITE 149
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5015
Practice Address - Country:US
Practice Address - Phone:361-776-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman