Organization
MANUS PRASERTHDAM,M.D.,P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUS PRASERTHDAM M.D. (OWNER)
(727) 894-1122
Entity
Organization
Contact information
Practice address
1201 5TH AVE N STE 208, ST PETERSBURG, FL 33705-1410
(727) 894-1122
(727) 894-0033
Mailing address
1201 5TH AVE N STE 208, ST PETERSBURG, FL 33705-1410
(727) 894-1122
(727) 894-0033
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0184828
CIGNA
FL
01
—
0666950
AETNA
FL
01
—
212769
AMERIGROUP
FL
01
—
3106012
UNITED HEALTHCARE
FL
05
—
62149
—
FL
Enumeration date
06/11/2009
Last updated
06/11/2009
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