Provider Demographics
NPI:1205803749
Name:MANNING, TYSHUNDA LAKESHA (MD)
Entity type:Individual
Prefix:DR
First Name:TYSHUNDA
Middle Name:LAKESHA
Last Name:MANNING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6546 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5708
Mailing Address - Country:US
Mailing Address - Phone:414-760-3250
Mailing Address - Fax:414-327-7639
Practice Address - Street 1:11211 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1035
Practice Address - Country:US
Practice Address - Phone:414-456-5000
Practice Address - Fax:414-327-7639
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45337207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII43431Medicare UPIN