Healthcare Provider Details

I. General information

NPI: 1427105022
Provider Name (Legal Business Name): JOSEPHINE MANTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N HIGHLAND AVE SUITE 2
AURORA IL
60506-1451
US

IV. Provider business mailing address

1300 N HIGHLAND AVE SUITE 2
AURORA IL
60506-1451
US

V. Phone/Fax

Practice location:
  • Phone: 630-897-9606
  • Fax: 630-897-9625
Mailing address:
  • Phone: 630-897-9606
  • Fax: 630-897-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036088055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: