MEDICARE: MANAHAN COMPREHENSIVE WELLNESS LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1811838774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANAHAN COMPREHENSIVE WELLNESS LLC

Provider Business Mailing Address
First Line	:	7567 CENTRAL PARKE BLVD STE C
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-6855
Country	:	US
Telephone Number	:	216-373-1858
Fax Number	:	419-359-8971

Provider Business Practice Location Address
First Line	:	7567 CENTRAL PARKE BLVD STE C
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-6855
Country	:	US
Telephone Number	:	216-373-1858
Fax Number	:	419-359-8971

Authorized Official
Title or Position	:	DO
Name	:	JILL MANAHAN
Credential	:
Telephone Number	:	216-373-1858

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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