Individual
MARK S MANNENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
39143
MN
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
39143
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209322700
—
MN
Enumeration date
02/06/2006
Last updated
01/19/2024
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