Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 27919 | MN |
NPI | 1003808049 |
---|---|
Provider Name | Jeffrey C. Manlove |
First Address | Minneapolis, MN 55404-3711 |
Second Address | Minneapolis, MN 55404-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 03/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0572003 | PREFERREDONE (01) | MN |
060087300 | (05) | MN |
1000010 | MEDICA PRIMARY (01) | MN |
100654 | UCARE (01) | MN |
1014249 | MEDICA CHOICE (01) | MN |
20938 | AMERICA'S PPO (01) | MN |
31360600 | MEDICAID - WISCONSIN (01) | MN |
38T54MA | BLUE SHIELD (01) | MN |
A94487 | (02) | MN |