MEDICARE: DR. MICHAEL DEAN MANUEL 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	208000000X	Pediatrics Physician	13249	LA

General Provider Information

NPI Number	:	1457332520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DEAN MANUEL M.D.

Provider Business Mailing Address
First Line	:	301 4TH ST
Second Line	:	MEDICAL TERRACE
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-8423
Country	:	US
Telephone Number	:	318-473-4632
Fax Number	:	318-473-4633

Provider Business Practice Location Address
First Line	:	301 4TH ST
Second Line	:	MEDICAL TERRACE
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-8423
Country	:	US
Telephone Number	:	318-473-4632
Fax Number	:	318-473-4633

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	05/24/2026

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