MEDICARE: DR. JILL C MANAHAN DO

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	207Q00000X	Family Medicine Physician	34008059M	OH

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	:	1740255546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL C MANAHAN DO

Provider Business Mailing Address
First Line	:	2753 ERIE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2204
Country	:	US
Telephone Number	:	513-246-8000
Fax Number	:	513-871-2824

Provider Business Practice Location Address
First Line	:	2753 ERIE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2204
Country	:	US
Telephone Number	:	513-246-8000
Fax Number	:	513-871-2824

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	06/23/2011

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