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General NPI Number Information
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NPI Number | 1306909148
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Entity Type | Individual
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Provider Name | EDWARD PHILIP MANN MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 5850 W 111TH ST
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415
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Country | US
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Telephone | 708-425-2466
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Fax | 708-425-4796
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Provider Business Mailing Address
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Address Line | PO BOX 379
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City | ORLAND PARK
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State | IL
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Zip | 60462-0379
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Country | US
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Telephone | 708-460-9836
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Fax | 708-460-1117
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036043622
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License Number State | IL
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