Healthcare Provider Details

I. General information

NPI: 1326498569
Provider Name (Legal Business Name): MANAS PARIKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 W DIVISION ST
CHICAGO IL
60622-2940
US

IV. Provider business mailing address

1701 W SUPERIOR ST
CHICAGO IL
60622-5646
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036149890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: