Provider Demographics
NPI:1063553543
Name:LONIAL, MANU (MD)
Entity type:Individual
Prefix:
First Name:MANU
Middle Name:
Last Name:LONIAL
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 1:1741 MESQUITE AVE # 100
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5695
Mailing Address - Country:US
Mailing Address - Phone:928-782-7972
Mailing Address - Fax:928-329-4522
Practice Address - Street 1:1741 MESQUITE AVE # 100
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5695
Practice Address - Country:US
Practice Address - Phone:928-782-7972
Practice Address - Fax:928-329-4522
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113596207Q00000X
AZ43225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ579940Medicaid
I47281Medicare UPIN
AZ579940Medicaid
Z142447Medicare PIN
AZZ181649Medicare PIN