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General NPI Number Information
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NPI Number | 1144375965
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Entity Type | Individual
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Provider Name | SUSAN AGUILA MANGAHAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1515 E LAKE ST SUITE 203
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City | HANOVER PARK
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State | IL
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Zip | 60133-4896
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Country | US
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Telephone | 630-830-5926
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Fax | 630-830-5938
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Provider Business Mailing Address
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Address Line | 1542 BLUESTEM LN
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City | GLENVIEW
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State | IL
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Zip | 60026-7775
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Country | US
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Telephone | 847-729-6574
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Fax | 847-486-0186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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