MEDICARE: DR. MICHAEL JON MANOLES 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	207RI0011X	Interventional Cardiology Physician	28957	MN

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	:	1578521555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JON MANOLES MD

Provider Business Mailing Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:	UNIVERSITY OF MINNESOTA PHYSICIANS
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414
Country	:	US
Telephone Number	:	612-884-0649
Fax Number	:	612-676-8992

Provider Business Practice Location Address
First Line	:	516 DELAWARE ST SE, PWB, CLINIC 3B
Second Line	:	CARDIOVASCULAR CENTER
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0356
Country	:	US
Telephone Number	:	612-365-5000
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	02/20/2013

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