Provider Demographics
NPI:1053320770
Name:SRA, MANNTEJ S (MD)
Entity type:Individual
Prefix:DR
First Name:MANNTEJ
Middle Name:S
Last Name:SRA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:13943 N 91ST AVE
Mailing Address - Street 2:BUILDING A, SUITE 102
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3629
Mailing Address - Country:US
Mailing Address - Phone:602-705-1353
Mailing Address - Fax:623-815-8299
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:BUILDING A, SUITE 102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3629
Practice Address - Country:US
Practice Address - Phone:602-705-1353
Practice Address - Fax:623-815-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-07-16
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Provider Licenses
StateLicense IDTaxonomies
AZ280332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology