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General NPI Number Information
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NPI Number | 1699977413
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Entity Type | Individual
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Provider Name | MANISH KUMAR DHAMIJA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST STE 623
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City | CHICAGO
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State | IL
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Zip | 60657-5196
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Country | US
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Telephone | 773-281-5818
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 N HALSTED ST STE 623
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City | CHICAGO
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State | IL
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Zip | 60657-5196
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Country | US
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Telephone | 773-281-5818
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Fax | 773-281-6895
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36117326
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | LT 12568
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License Number State | ND
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