Provider Demographics
NPI:1548256316
Name:TEVES-MANI, MILAGROS D (MD)
Entity type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:D
Last Name:TEVES-MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:D
Other - Last Name:TEVES-MANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 304
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7915
Mailing Address - Country:US
Mailing Address - Phone:270-538-5596
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-444-4250
Practice Address - Fax:270-444-4260
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197174207R00000X
KY52415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01542070Medicaid
NY01542070Medicaid
NYF96496Medicare UPIN