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NPI Code Detail

MEDICARE: VIJAY KRISHNA MANNE M.D.

MEDICARE: VIJAY KRISHNA MANNE 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
1208M00000XHospitalist Physician145445CA
2208000000XPediatrics Physician4301500780MI

General Provider Information

NPI Number : 1265850440
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIJAY KRISHNA MANNE M.D.
Provider Business Mailing Address
First Line : 9300 VALLEY CHILDRENS PL
Second Line :
City : MADERA
State : CA
Zip : 93636-8761
Country : US
Telephone Number : 559-353-5700
Fax Number : 559-353-5708
Provider Business Practice Location Address
First Line : 3901 BEAUBIEN ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-966-0128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2014
Last Update Date : 02/12/2026

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