=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346535945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOEL U MANN LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2011
-----------------------------------------------------
Last Update Date | 06/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6420 W 127TH ST SUITE 108
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-371-7838
-----------------------------------------------------
Fax | 708-371-7839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6420 W 127TH ST SUITE 108
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-371-7838
-----------------------------------------------------
Fax | 708-371-7839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOEL U MANN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 708-371-7838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------