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NPI Code Detail

MEDICARE: ANDREA TERESA DIMICHELE-MANES M.D.

MEDICARE:   ANDREA TERESA DIMICHELE-MANES  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
1207V00000XObstetrics & Gynecology Physician200601542NC
2207V00000XObstetrics & Gynecology Physician04-45692KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689774788
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA TERESA DIMICHELE-MANES M.D.
Provider Business Mailing Address
First Line : 11083 W 2 1/2 MILE RD
Second Line :
City : CHUBBUCK
State : ID
Zip : 83202-5208
Country : US
Telephone Number : 910-639-5703
Fax Number :
Provider Business Practice Location Address
First Line : 310 E WALNUT ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5572
Country : US
Telephone Number : 620-275-9752
Fax Number : 620-275-4306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 05/06/2024

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Directions to “ ANDREA TERESA DIMICHELE-MANES M.D.” Practice Location

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