Individual
WINSTON MANIMTIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3593
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3593
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
2000158751
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100381700G
—
KS
05
—
205156607
—
MO
01
—
29814041
BCBS OF KC (INCLUDES PHP)
MO
01
—
399160
FIRST GUARD
MO
01
—
62202
COVENTRY
MO
01
—
7785745
CIGNA
MO
Enumeration date
06/01/2006
Last updated
09/10/2013
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