Individual
DR. TYRONE CHRISTOPHER A. MANALAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2400 17TH ST, COLUMBUS, IN 47201-5351
(812) 376-5974
(812) 375-3203
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01066591A
IN
208M00000X
Hospitalist Physician
Primary
01066591A
IN
208M00000X
Hospitalist Physician
0166591A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200969260
C2MEDICAID
IN
Enumeration date
04/04/2007
Last updated
09/09/2024
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