MEDICARE: MR. AJAIB S MANN SR. M.D.

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	207R00000X	Internal Medicine Physician	ME66835	FL
2	207R00000X	Internal Medicine Physician	ME 66835	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033171277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AJAIB S MANN SR. M.D.

Provider Business Mailing Address
First Line	:	1806 NORTH PINE ISLAND RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322
Country	:	US
Telephone Number	:	954-474-0110
Fax Number	:	954-424-9859

Provider Business Practice Location Address
First Line	:	1806 NORTH PINE ISLAND RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322
Country	:	US
Telephone Number	:	954-474-0110
Fax Number	:	954-424-9859

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	01/21/2010

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