Individual
MIA L MANABAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2424 S 90TH ST STE 300, WEST ALLIS, WI 53227
(414) 328-8750
(586) 582-6631
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
69852-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100080507
—
WI
Enumeration date
05/16/2012
Last updated
08/15/2024
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