Organization
DAVID L MANZO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L MANZO M.D. (OWNER)
(248) 541-4200
Entity
Organization
Contact information
Practice address
621 W 11 MILE RD, ROYAL OAK, MI 48067-2201
(248) 541-4200
(248) 541-4969
Mailing address
621 W 11 MILE RD, ROYAL OAK, MI 48067-2201
(248) 541-4200
(248) 541-4969
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1806373281
BLUE CROSS/BLUE SHIELD OF MI
MI
01
—
4113369
AETNA
MI
05
—
4229975 TYPE 10
—
MI
Enumeration date
05/08/2008
Last updated
02/10/2010
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