Individual
ANNE MANKTELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2835 FORT MISSOULA ROAD, STE 306 PEDIATRIC SURGERY OF MONTANA, MISSOULA, MT 59804
(406) 327-4730
Mailing address
PO BOX 16900, MISSOULA, MT 59808
(406) 327-4620
(406) 549-5928
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
MT10170
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096560
—
MT
Enumeration date
08/09/2006
Last updated
07/08/2007
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