Individual
PANNEER SELVAN MANICKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1381 WESTGATE CENTER DR, WINSTON SALEM, NC 27103-2934
(336) 718-0100
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 718-4820
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2016-02003
NC
207R00000X
Internal Medicine Physician
43289
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34088600
—
WI
Enumeration date
09/23/2006
Last updated
04/26/2023
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