Healthcare Provider Details

I. General information

NPI: 1780699199
Provider Name (Legal Business Name): MANOHAR AWATRAMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST CENTRAL RD
ARLINGTON HEIGHTS IL
60005
US

IV. Provider business mailing address

PO BOX 88648
CHICAGO IL
60680-1648
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-7060
  • Fax:
Mailing address:
  • Phone: 800-444-6110
  • Fax: 847-615-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036056542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: