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General NPI Number Information
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NPI Number | 1871484345
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Entity Type | Individual
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Provider Name | KEERTHANA MANJUNATH MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1950 W POLK ST STE 5210
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 312-864-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 513 S DAMEN AVE APT 1802
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City | CHICAGO
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State | IL
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Zip | 60612-5596
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Country | US
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Telephone | 312-221-6462
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Fax |
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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 | 125.085279
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License Number State | IL
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