Individual
MARC MANTZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8501 NW MADISCHE RD, LAWTON, OK 73507-1221
(580) 713-8374
Mailing address
8501 NW MADISCHE RD, LAWTON, OK 73507-1221
(580) 713-8374
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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