1609951771 NPI number — JUAN CARLOS MANIVEL M.D.

Table of content: JUAN CARLOS MANIVEL M.D. (NPI 1609951771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609951771 NPI number — JUAN CARLOS MANIVEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANIVEL
Provider First Name:
JUAN
Provider Middle Name:
CARLOS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609951771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE ST SE
Provider Second Line Business Mailing Address:
MMC 609
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55455-0341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-626-0622
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 DELAWARE ST SE
Provider Second Line Business Practice Location Address:
760 MAYO BLDG
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455-0341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-626-0622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  29459 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0039975 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0515908 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1122550 . This is a "MEDICA CHOICE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2T224MA . This is a "BCBS MN NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP22293 . This is a "HEALTHPARTNERS NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1174545 . This is a "MEDICA DUAL SOLUTIONS NO." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 101364 . This is a "UCARE NO." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 32455000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 719205300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009228 . This is a "PREFERRED ONE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 768244 . This is a "AMERICA'S PPO NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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