Healthcare Provider Details

I. General information

NPI: 1003157249
Provider Name (Legal Business Name): DAVID R MANWILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S MAIN ST
ANN ARBOR MI
48104-3786
US

IV. Provider business mailing address

1310 S MAIN ST
ANN ARBOR MI
48104-3786
US

V. Phone/Fax

Practice location:
  • Phone: 734-716-7049
  • Fax:
Mailing address:
  • Phone: 734-716-7049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: