MEDICARE: DANIELLE M MANN D.O.

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	207V00000X	Obstetrics & Gynecology Physician	036121101	IL
2	207V00000X	Obstetrics & Gynecology Physician	03261	KY

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
2	000000666549	OTHER	KY	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	50028686	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1174787725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE M MANN D.O.

Provider Business Mailing Address
First Line	:	2700 STANLEY GAULT PKWY STE 129
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5176
Country	:	US
Telephone Number	:	502-253-4917
Fax Number	:	502-489-5751

Provider Business Practice Location Address
First Line	:	1023 NEW MOODY LANE
Second Line	:	SUITE 103
City	:	LAGRANGE
State	:	KY
Zip	:	40031-9179
Country	:	US
Telephone Number	:	502-222-5558
Fax Number	:	502-222-3040

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	11/14/2025

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Directions to “ DANIELLE M MANN D.O.” Practice Location

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