Healthcare Provider Details

I. General information

NPI: 1114345402
Provider Name (Legal Business Name): SAVIO MANATT SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20060 GOVERNORS DR SUITE 204
OLYMPIA FIELDS IL
60461-1029
US

IV. Provider business mailing address

20060 GOVERNORD DRIVE SUITE 204
OLYMPIA FIELDS IL
60461-1099
US

V. Phone/Fax

Practice location:
  • Phone: 708-283-8300
  • Fax: 708-283-9245
Mailing address:
  • Phone: 708-283-8300
  • Fax: 708-283-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036069553
License Number StateIL

VIII. Authorized Official

Name: MRS. ALEX SOLIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-283-8300