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General NPI Number Information
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NPI Number | 1114345402
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Entity Type | Organization
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Legal Business Name | SAVIO MANATT SC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 20060 GOVERNORS DR SUITE 204
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1029
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Country | US
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Telephone | 708-283-8300
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Fax | 708-283-9245
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Provider Business Mailing Address
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Address Line | 20060 GOVERNORD DRIVE SUITE 204
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1099
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Country | US
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Telephone | 708-283-8300
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Fax | 708-283-9245
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ALEX SOLIS
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Credential |
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Telephone | 708-283-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 036069553
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License Number State | IL
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