Provider Demographics
NPI:1962400234
Name:MANUEL, EMMANUEL SISON (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:SISON
Last Name:MANUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 S 16TH ST
Mailing Address - Street 2:STE 1015
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4537
Mailing Address - Country:US
Mailing Address - Phone:414-643-4300
Mailing Address - Fax:414-384-4332
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:STE 1015
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4537
Practice Address - Country:US
Practice Address - Phone:414-643-4300
Practice Address - Fax:414-384-4332
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI22808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30299800Medicaid
000101989Medicare PIN
WI30299800Medicaid