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General NPI Number Information
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NPI Number | 1790839520
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Entity Type | Individual
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Provider Name | LUIS M MANGUBAT M.D., S.C.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 800 BIESTERFIELD RD SUITE 407
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3361
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Country | US
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Telephone | 815-588-3866
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Fax | 815-588-3006
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Provider Business Mailing Address
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Address Line | 800 BIESTERFIELD RD SUITE 407
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3378
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Country | US
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Telephone | 815-588-3866
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Fax | 815-588-3006
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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