Provider Demographics
NPI:1699709089
Name:MANGER, PHILIP (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MANGER
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 1:13359 ISLE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56425-2223
Mailing Address - Country:US
Mailing Address - Phone:218-454-3077
Mailing Address - Fax:888-835-7231
Practice Address - Street 1:13359 ISLE DR STE 1
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-2223
Practice Address - Country:US
Practice Address - Phone:218-454-8888
Practice Address - Fax:888-835-7231
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47977207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN156657100Medicaid
MN040001036Medicare PIN