Provider Demographics
NPI:1184409617
Name:ERIC J MANCINI MD, PC
Entity type:Organization
Organization Name:ERIC J MANCINI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANCINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-6688
Mailing Address - Street 1:2230 E MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-6601
Mailing Address - Country:US
Mailing Address - Phone:231-487-6688
Mailing Address - Fax:231-865-3436
Practice Address - Street 1:2230 E MITCHELL RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-6601
Practice Address - Country:US
Practice Address - Phone:231-487-6688
Practice Address - Fax:231-865-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty