Provider Demographics
NPI:1962553685
Name:MANYAM, VANI (MD)
Entity type:Individual
Prefix:MRS
First Name:VANI
Middle Name:
Last Name:MANYAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANI
Other - Middle Name:
Other - Last Name:PINNAMANENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1051 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3636
Mailing Address - Country:US
Mailing Address - Phone:810-720-1730
Mailing Address - Fax:810-720-1736
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3638
Practice Address - Country:US
Practice Address - Phone:810-720-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053827207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2836051Medicaid
MIB76335Medicare UPIN
MI2836051Medicaid