Healthcare Provider Details

I. General information

NPI: 1376540385
Provider Name (Legal Business Name): MANISH M THUSAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BAY PARK DR 202
OREGON OH
43616-4921
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4231
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-0711
  • Fax:
Mailing address:
  • Phone: 419-693-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35082131T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: