Provider Demographics
NPI:1215907506
Name:MANICA, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MANICA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:28595 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2977
Mailing Address - Country:US
Mailing Address - Phone:248-553-0010
Mailing Address - Fax:248-553-5957
Practice Address - Street 1:28595 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2977
Practice Address - Country:US
Practice Address - Phone:248-553-0010
Practice Address - Fax:248-553-5957
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-02-27
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Provider Licenses
StateLicense IDTaxonomies
MI0297292084N0400X
MI4301029729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4721188Medicaid
MI4721188Medicaid
MIB44885Medicare UPIN