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General NPI Number Information
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NPI Number | 1306074778
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Entity Type | Individual
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Provider Name | MICAH DAVID MANN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 308 W 37TH ST
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City | AUSTIN
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State | TX
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Zip | 78705-1418
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Country | US
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Telephone | 646-648-3563
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Fax | 737-241-0956
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Provider Business Mailing Address
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Address Line | 308 W 37TH ST
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City | AUSTIN
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State | TX
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Zip | 78705-1418
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Country | US
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Telephone | 646-648-3563
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q7072
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 258007
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License Number State | NY
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