Healthcare Provider Details

I. General information

NPI: 1982675310
Provider Name (Legal Business Name): MANALI S AMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANALI S AMIN MISHRA MD

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 75TH ST STE 302
NAPERVILLE IL
60540-9310
US

IV. Provider business mailing address

1331 W 75TH ST STE 302
NAPERVILLE IL
60540-9310
US

V. Phone/Fax

Practice location:
  • Phone: 630-761-5531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number220177
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036127893
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number036.127893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: