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General NPI Number Information
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NPI Number | 1144230368
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Entity Type | Individual
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Provider Name | ANNE MANKTELOW MD
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2835 FORT MISSOULA ROAD STE 306 PEDIATRIC SURGERY OF MONTANA
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City | MISSOULA
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State | MT
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Zip | 59804
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Country | US
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Telephone | 406-327-4730
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16900
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-327-4620
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Fax | 406-549-5928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | MT10170
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License Number State | MT
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