Provider Demographics
NPI:1548252455
Name:MANTHEI, CARL R (DO)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:MANTHEI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 S EASTERN
Mailing Address - Street 2:#200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-473-5455
Mailing Address - Fax:702-405-7960
Practice Address - Street 1:10120 S EASTERN
Practice Address - Street 2:#200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-473-5455
Practice Address - Fax:702-405-7960
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV282207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200211502Medicaid
NV50039261Medicare PIN
NV200211502Medicaid