Healthcare Provider Details

I. General information

NPI: 1902549439
Provider Name (Legal Business Name): VIKAS MANJUNATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E MAIN ST STE 219
BARRINGTON IL
60010-3203
US

IV. Provider business mailing address

330 E MAIN ST STE 219
BARRINGTON IL
60010-3203
US

V. Phone/Fax

Practice location:
  • Phone: 847-847-4989
  • Fax: 847-227-2207
Mailing address:
  • Phone: 847-847-4989
  • Fax: 847-227-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.172638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: