Provider Demographics
NPI:1952507709
Name:MANN, MANITH (MD)
Entity Type:Individual
Prefix:
First Name:MANITH
Middle Name:
Last Name:MANN
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 1:2120 W 24TH ST
Mailing Address - Street 2:#A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6122
Mailing Address - Country:US
Mailing Address - Phone:928-782-6015
Mailing Address - Fax:
Practice Address - Street 1:2120 W 24TH ST
Practice Address - Street 2:#A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6122
Practice Address - Country:US
Practice Address - Phone:928-782-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine