Individual
KURMANATH MANYAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
461 W HURON ST, PONTIAC, MI 48341-1601
(248) 857-7200
Mailing address
3005 CROFT WAY, BLOOMFIELD HILLS, MI 48302-1180
(810) 610-2809
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301053092
MI
174400000X
Specialist
KM053092
MI
207L00000X
Anesthesiology Physician
Primary
4301053092
MI
Other
Enumeration date
08/22/2006
Last updated
05/13/2016
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