Individual
DR. KOTI R MANNEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3150 GERSHWIN DRIVE, GREEN BAY, WI 54311-5859
(920) 391-4700
(920) 391-4870
Mailing address
3150 GERSHWIN DRIVE, GREEN BAY, WI 54311-5859
(920) 391-4700
(920) 391-4870
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
24001
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720188717
—
WI
Enumeration date
09/22/2006
Last updated
03/17/2025
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