Healthcare Provider Details

I. General information

NPI: 1164168134
Provider Name (Legal Business Name): BENJAMIN MCMANUS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 GOODLETTE RD STE 160
NAPLES FL
34102-5457
US

IV. Provider business mailing address

681 GOODLETTE RD STE 160
NAPLES FL
34102-5457
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-0200
  • Fax: 239-263-8435
Mailing address:
  • Phone: 239-263-0200
  • Fax: 239-263-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: