Provider Demographics
NPI:1174787725
Name:MANN, DANIELLE M (DO)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:MANN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5132
Mailing Address - Country:US
Mailing Address - Phone:502-253-4917
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1023 NEW MOODY LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9179
Practice Address - Country:US
Practice Address - Phone:502-222-5558
Practice Address - Fax:502-222-3040
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036121101207V00000X
KY03261207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000666549OtherANTHEM
KY50028686OtherPASSPORT
KY7100115010Medicaid
KY000000666549OtherANTHEM