Healthcare Provider Details

I. General information

NPI: 1083671341
Provider Name (Legal Business Name): MANUEL ALBERTO FRANCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE 508
CHICAGO IL
60622-1797
US

IV. Provider business mailing address

1431 N WESTERN AVE STE 503
CHICAGO IL
60622-1774
US

V. Phone/Fax

Practice location:
  • Phone: 773-489-7648
  • Fax: 773-489-2078
Mailing address:
  • Phone: 773-772-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036099241
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: