Mannem, Koti R
Mannem, Koti R is an individual health care provider with primary practice located at 3150 Gershwin Drive , Green Bay WI 54311-5859. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Mannem, Koti R can be contacted via phone (920) 391-4700.Contact Information
Primary practice address
3150 Gershwin Drive
Green Bay WI 54311-5859
Phone: (920) 391-4700
Fax: (920) 391-4870
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 24001 | Wisconsin |
Profile Details
| NPI number | 1720188717 |
|---|---|
| LBN Legal business name | Mannem, Koti R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 22nd, 2006 |
| Last updated | Mar 25th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720188717 | NPPES |
| Wisconsin | MEDICAID | 1720188717 |
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