MEDICARE: DR. KEIKO MCMANUS 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	207Y00000X	Otolaryngology Physician	F9807	TX

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	:	1568443380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEIKO MCMANUS M.D.

Provider Business Mailing Address
First Line	:	4330 MEDICAL DR
Second Line	:	STE 150
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3324
Country	:	US
Telephone Number	:	210-614-5600
Fax Number	:	210-614-8963

Provider Business Practice Location Address
First Line	:	7909 FREDERICKSBURG RD
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3425
Country	:	US
Telephone Number	:	210-614-5600
Fax Number	:	210-614-8963

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	12/19/2019

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