Provider Demographics
NPI:1881879757
Name:DAVID W MANSKY DPM, PC
Entity type:Organization
Organization Name:DAVID W MANSKY DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-945-2222
Mailing Address - Street 1:1127 W STATE ST
Mailing Address - Street 2:SUITE #B
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-7755
Mailing Address - Country:US
Mailing Address - Phone:269-945-2222
Mailing Address - Fax:269-948-2223
Practice Address - Street 1:1127 W STATE ST
Practice Address - Street 2:SUITE #B
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-7755
Practice Address - Country:US
Practice Address - Phone:269-945-2222
Practice Address - Fax:269-948-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001735213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION71500Medicare PIN
MI4496910002Medicare NSC