MEDICARE: DR. CHARLES J MANAK 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	207R00000X	Internal Medicine Physician	29950	CO
2	208M00000X	Hospitalist Physician	42452	AZ

General Provider Information

NPI Number	:	1740283878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES J MANAK M.D.

Provider Business Mailing Address
First Line	:	5777 E MAYO BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-4502
Country	:	US
Telephone Number	:	480-301-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5777 E MAYO BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054
Country	:	US
Telephone Number	:	480-301-8000
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/08/2020

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Directions to “ DR. CHARLES J MANAK M.D.” Practice Location

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