MEDICARE: DR. JOHN MANION M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	17358	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	373005	OTHER	MN	PREFERRED ONE
2	0413229	OTHER	MN	MEDICA
3	0413229	OTHER	MN	SELECT CARE
4	101041	OTHER	MN	UCARE
5	4T905MA	OTHER	MN	BLUE CROSS BLUE SHIELD
6	A94694	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1073605952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MANION M.D.

Provider Business Mailing Address
First Line	:	3435 WEST BROADWAY
Second Line	:	SUITE 1065
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422
Country	:	US
Telephone Number	:	763-520-1137
Fax Number	:	763-520-1976

Provider Business Practice Location Address
First Line	:	3435 WEST BROADWAY
Second Line	:	SUITE 1065
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422
Country	:	US
Telephone Number	:	763-520-1137
Fax Number	:	763-520-1976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN MANION M.D.” Practice Location

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