Provider Demographics
NPI:1053353540
Name:DAVID W. MANSKY,D.P.M.,P.C.
Entity type:Organization
Organization Name:DAVID W. MANSKY,D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-674-3124
Mailing Address - Street 1:5770 HIGHLAND RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1826
Mailing Address - Country:US
Mailing Address - Phone:248-674-3124
Mailing Address - Fax:
Practice Address - Street 1:5770 HIGHLAND RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1826
Practice Address - Country:US
Practice Address - Phone:248-674-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001735213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856351410OtherBCBS
MI3108483OtherMOLINA
MI3108483Medicaid
MI4496910001Medicare NSC
MI3108483Medicaid
MIU54517Medicare UPIN