MEDICARE: MANU LONIAL 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	207Q00000X	Family Medicine Physician	036113596	IL
2	207Q00000X	Family Medicine Physician	43225	AZ

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	:	1063553543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANU LONIAL M.D.

Provider Business Mailing Address
First Line	:	1741 MESQUITE AVE # 100
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5695
Country	:	US
Telephone Number	:	928-782-7972
Fax Number	:	928-329-4522

Provider Business Practice Location Address
First Line	:	1741 MESQUITE AVE # 100
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5695
Country	:	US
Telephone Number	:	928-782-7972
Fax Number	:	928-329-4522

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	05/01/2017

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