MEDICARE: MICHAEL D MANUEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	2172	AK

General Provider Information

NPI Number	:	1003831488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D MANUEL MD

Provider Business Mailing Address
First Line	:	2741 DEBARR RD STE C215
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-2978
Country	:	US
Telephone Number	:	907-563-2002
Fax Number	:	907-562-7628

Provider Business Practice Location Address
First Line	:	2741 DEBARR RD STE C215
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-2978
Country	:	US
Telephone Number	:	907-563-2002
Fax Number	:	907-562-7628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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