Healthcare Provider Details

I. General information

NPI: 1336181791
Provider Name (Legal Business Name): HARI K. MANNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N WELO ST
TIOGA ND
58852-7117
US

IV. Provider business mailing address

PO BOX 159
TIOGA ND
58852-0159
US

V. Phone/Fax

Practice location:
  • Phone: 701-664-3368
  • Fax: 701-664-3300
Mailing address:
  • Phone: 701-664-3368
  • Fax: 701-664-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9412
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP4481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: