Individual
DR. MANISH MANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8087 CASTLETON RD, INDIANAPOLIS, IN 46250-2053
(317) 660-2173
(317) 660-2393
Mailing address
PO BOX 80158, INDIANAPOLIS, IN 46280-0158
(317) 660-2173
(317) 660-2393
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01062145A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01062145A
INDIANA LICENSE
IN
01
—
01062145B
CSR
IN
Enumeration date
07/01/2006
Last updated
03/07/2023
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