Individual
MICHAEL D MANNEBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-8616
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
34347
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200022495
RAILROAD MEDICARE
WI
05
—
31957300
—
WI
Enumeration date
11/15/2005
Last updated
03/02/2016
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