Healthcare Provider Details

I. General information

NPI: 1194067298
Provider Name (Legal Business Name): MANAN CHETAN TRIVEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S MICHIGAN AVE
CHICAGO IL
60616-1209
US

IV. Provider business mailing address

PO BOX 14382
BELFAST ME
04915-4036
US

V. Phone/Fax

Practice location:
  • Phone: 312-535-5770
  • Fax:
Mailing address:
  • Phone: 773-270-5600
  • Fax: 773-360-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036139175
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036139175
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: