Provider Demographics
NPI:1770976631
Name:MANNAN MD MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:MANNAN MD MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHOYEB
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-886-8880
Mailing Address - Street 1:5230 KY ROUTE 321
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9168
Mailing Address - Country:US
Mailing Address - Phone:606-889-9994
Mailing Address - Fax:606-889-0909
Practice Address - Street 1:5230 KY ROUTE 321
Practice Address - Street 2:SUITE 6
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9168
Practice Address - Country:US
Practice Address - Phone:606-889-9994
Practice Address - Fax:606-889-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty