Provider Demographics
NPI:1730156506
Name:MANHEIM, JONATHAN C (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:MANHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N. WHEELING STREET
Mailing Address - Street 2:MAILSTOP 111
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 N. WHEELING STREET
Practice Address - Street 2:MAILSTOP 111
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-295-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35454208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025742100Medicaid
UTZ3332Medicaid
CO01354547Medicaid
SD7725890Medicaid
NY03316218Medicaid
WY1730156506Medicaid
KS200389220AMedicaid
NM30303532Medicaid
NM30303532Medicaid
WY1730156506Medicaid
COCOA109083Medicare PIN
CO404115ZGWFMedicare PIN
CO01354547Medicaid
UTZ3332Medicaid