Provider Demographics
NPI:1962533018
Name:MICHAEL MANUEL,MD,PC
Entity type:Organization
Organization Name:MICHAEL MANUEL,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-563-2002
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:C-215
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-563-2002
Mailing Address - Fax:907-562-7628
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:C-215
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-563-2002
Practice Address - Fax:907-562-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
151516Medicare ID - Type UnspecifiedGROUP NUMBER