Healthcare Provider Details

I. General information

NPI: 1538275243
Provider Name (Legal Business Name): MANOJ K NAYAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S. 20TH STREET #100
MILWAUKEE WI
53215-4940
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-1808
  • Fax: 414-645-1170
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45655-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: