Basic Information
| Provider Information | |||||||||
| NPI: | 1235212713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANAHAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 EAST FRANKLIN AVE | ||||||||
| Address2: | UFP SMILEY'S CLINIC, UNIVERSITY OF MN PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2615 EAST FRANKLIN AVE | ||||||||
| Address2: | UFP SMILEY'S CLINIC, UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 17751 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 299J2MA | 01 | BLUE CROSS BLUE SHIELD | OTHER | 894137 | 01 | ARAZ | OTHER | HP18753 | 01 | HEALTH PARTNERS | OTHER | 1938175 | 05 | IA | MEDICAID | 01-09659 | 01 | MEDICA CHOICE | OTHER | 114700 | 01 | UCARE | OTHER | 1011064 | 01 | PREFERRED ONE | OTHER | 34311400 | 05 | WI | MEDICAID |