Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101102721 | VA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 0101102721 | VA |
NPI | 1114965159 |
---|---|
Provider Name | Chad R Manke |
First Address | Va Beach, VA 23462 |
Second Address | Va Beach, VA 23456-0167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 12/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004436V01 | MEDICARE PTAN (01) | VA |
010064279 | (05) | VA |
I05721 | (02) |