Individual
DR. JOHN THOMAS MANIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1169 EASTERN PKWY STE 2358, LOUISVILLE, KY 40217
(502) 890-9979
(844) 521-8730
Mailing address
1169 EASTERN PKWY STE 2358, LOUISVILLE, KY 40217-1415
(502) 890-9979
(844) 521-8730
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02004524A
IN
207Q00000X
Family Medicine Physician
Primary
04003
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02004524A
PLA IN MEDICAL LICENSING AGENCY
IN
01
—
04003
KBML
KY
01
—
18708
AMERICAN OSTEOPATHIC ASSOCIATION BOARD CERTIFICATION IN FAMILY MEDICINE/OMT
—
Enumeration date
04/17/2013
Last updated
07/13/2023
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