Provider Demographics
NPI:1922042811
Name:MANN, MICHAEL ODELL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ODELL
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4053 LONE TREE WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6200
Mailing Address - Country:US
Mailing Address - Phone:925-756-3427
Mailing Address - Fax:925-756-3450
Practice Address - Street 1:3901 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6200
Practice Address - Country:US
Practice Address - Phone:925-779-7274
Practice Address - Fax:925-706-1686
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG37019207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G370190OtherBS OF CA
CA00G370190Medicaid
CA00G370190OtherBS OF CA
CA00G370191Medicare ID - Type Unspecified