Healthcare Provider Details

I. General information

NPI: 1316568207
Provider Name (Legal Business Name): MANASI SEJPAL M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date: 01/11/2022
Reactivation Date: 04/06/2022

III. Provider practice location address

10837 S CICERO AVE FL 2
OAK LAWN IL
60453-6458
US

IV. Provider business mailing address

10837 S CICERO AVE FL 2
OAK LAWN IL
60453-6458
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-7575
  • Fax:
Mailing address:
  • Phone: 708-636-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.165397
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: