Healthcare Provider Details

I. General information

NPI: 1871855106
Provider Name (Legal Business Name): DEBORAH MANST MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S WOOD ST
CHICAGO IL
60608-1202
US

IV. Provider business mailing address

818 S WOLCOTT AVE STE 423
CHICAGO IL
60612-3704
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2000
  • Fax:
Mailing address:
  • Phone: 312-355-8091
  • Fax: 909-206-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number036149273
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR73389
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: