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General NPI Number Information
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NPI Number | 1760588024
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Entity Type | Individual
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Provider Name | MARY ELIZABETH MANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 3009 N BALLAS RD SUITE 250C
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City | ST LOUIS
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State | MO
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Zip | 63131
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Country | US
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Telephone | 314-567-9199
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Fax | 314-432-1524
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Provider Business Mailing Address
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Address Line | 180 WEIDMAN ROAD SUITE 125
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City | ST LOUIS
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State | MO
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Zip | 63021
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Country | US
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Telephone | 636-207-0277
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Fax | 636-207-0221
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 100216
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License Number State | MO
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