Provider Demographics
NPI:1336181791
Name:MANNE, HARI K (MD)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:K
Last Name:MANNE
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:ND
Mailing Address - Zip Code:58852-0159
Mailing Address - Country:US
Mailing Address - Phone:701-664-3368
Mailing Address - Fax:701-664-3300
Practice Address - Street 1:710 N WELO ST
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:ND
Practice Address - Zip Code:58852-7117
Practice Address - Country:US
Practice Address - Phone:701-664-3368
Practice Address - Fax:701-664-3300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23346OtherBCBSND
ND12414Medicaid
P00148264Medicare ID - Type UnspecifiedRR MEDICARE
NDN23346Medicare ID - Type UnspecifiedMEDICARE B
NDH90587Medicare UPIN