Provider Demographics
NPI:1700073897
Name:MANIMEKALAI, NATESAN (MD)
Entity type:Individual
Prefix:
First Name:NATESAN
Middle Name:
Last Name:MANIMEKALAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5900
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5900
Practice Address - Fax:601-984-6439
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97927207L00000X
MS22847207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03950227Medicaid
FL2797470-00Medicaid
MSP010508103OtherRAILROAD MEDICARE PTAN
GA785534386AMedicaid
MSP010508103OtherRAILROAD MEDICARE PTAN
GA785534386AMedicaid
MS327833YJ5DMedicare PIN
FLAH439ZMedicare PIN