Healthcare Provider Details

I. General information

NPI: 1528427861
Provider Name (Legal Business Name): AARON D MANSHAEM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 800
CHICAGO IL
60611-2978
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 800
CHICAGO IL
60611-2978
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5753
  • Fax: 312-695-5645
Mailing address:
  • Phone: 312-695-5753
  • Fax: 312-695-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005752
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61556
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085005752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: