Individual
DR. MICHAEL J MANALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
615 S NEW BALLAS RD DEPT OF, SAINT LOUIS, MO 63141-8221
(314) 251-6000
(636) 200-4243
Mailing address
339 CONSORT DR, BALLWIN, MO 63011-4439
(636) 386-9224
(636) 386-7679
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
04-26424
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100266320A
—
KS
05
—
207973322
—
MO
01
—
50044840
RR MEDICARE
KS
Enumeration date
02/28/2006
Last updated
03/21/2023
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