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General NPI Number Information
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NPI Number | 1831320621
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Entity Type | Individual
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Provider Name | LISETH MANJARREZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 675 W CENTRAL RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-2376
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Country | US
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Telephone | 847-342-1554
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Fax | 847-342-1711
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Provider Business Mailing Address
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Address Line | 675 W CENTRAL RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-2376
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Country | US
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Telephone | 847-342-1554
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Fax | 847-342-1711
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301094777
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.130521
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License Number State | IL
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