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General NPI Number Information
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NPI Number | 1740765700
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Entity Type | Organization
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Legal Business Name | NANI INTERNAL MED LLC
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 6438 JOLIET RD STE 203
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-4624
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Country | US
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Telephone | 708-352-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W 22ND ST
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City | OAK BROOK
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State | IL
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Zip | 60523-1557
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Country | US
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Telephone | 630-974-5216
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MANISH TANNA
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Credential |
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Telephone | 630-573-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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