MEDICARE: CHRISTIAN P. MANNSFELD 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	207P00000X	Emergency Medicine Physician	036-115277	IL
2	207P00000X	Emergency Medicine Physician	G88465	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	315763	OTHER	WY	BSWY
2	036-115277	OTHER	IL	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1104844935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN P. MANNSFELD MD

Provider Business Mailing Address
First Line	:	8038 DOUGLAS RANCH DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6157
Country	:	US
Telephone Number	:	916-872-4320
Fax Number	:

Provider Business Practice Location Address
First Line	:	11111 WILCREST GREEN DR
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77042-4813
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/27/2020

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