MEDICARE: DR. MICHAEL RICHARD MANN 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	K9842	TX

General Provider Information

NPI Number	:	1326026519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD MANN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 630786
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-0786
Country	:	US
Telephone Number	:	713-266-5225
Fax Number	:	713-266-5335

Provider Business Practice Location Address
First Line	:	2500 FONDREN RD
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77063-2313
Country	:	US
Telephone Number	:	713-266-5225
Fax Number	:	713-266-5335

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/01/2008

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