Healthcare Provider Details

I. General information

NPI: 1053641720
Provider Name (Legal Business Name): MANNING MICHAEL THALER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: M MICHAEL THALER M.D.

II. Dates (important events)

Enumeration Date: 01/01/2010
Last Update Date: 01/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CASTENADA AVE
SAN FRANCISCO CA
94116-1406
US

IV. Provider business mailing address

35 CASTENADA AVE
SAN FRANCISCO CA
94116-1406
US

V. Phone/Fax

Practice location:
  • Phone: 415-664-9316
  • Fax: 415-664-6554
Mailing address:
  • Phone: 415-664-9316
  • Fax: 415-664-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG6901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG6901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: