Provider Demographics
NPI:1295791770
Name:MANUEL, LOUIS C (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:C
Last Name:MANUEL
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 1:1734 E 63RD ST
Mailing Address - Street 2:STE 501
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3543
Mailing Address - Country:US
Mailing Address - Phone:816-363-4700
Mailing Address - Fax:
Practice Address - Street 1:1734 E 63RD ST
Practice Address - Street 2:STE 501
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3543
Practice Address - Country:US
Practice Address - Phone:816-363-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3701207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
181077454OtherRAILROAD MEDICARE
MO200044105Medicaid
431023012OtherHUMANA
431023012OtherHUMANA
MO200044105Medicaid