MEDICARE: DR. ANDRE MANOV MD

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	207R00000X	Internal Medicine Physician	K2239	TX
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	19604	NV
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	K2239	TX
4	207R00000X	Internal Medicine Physician	19604	NV

General Provider Information

NPI Number	:	1801829676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE MANOV MD

Provider Business Mailing Address
First Line	:	PO BOX 100744
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 N TENAYA WAY STE 400
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0642
Country	:	US
Telephone Number	:	702-962-9550
Fax Number	:	702-962-5536

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/03/2024

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Directions to “ DR. ANDRE MANOV MD” Practice Location

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