MEDICARE: GENTI MANCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209014660	IL

General Provider Information

NPI Number	:	1760936090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENTI MANCO

Provider Business Mailing Address
First Line	:	120 W 22ND ST STE 200
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1563
Country	:	US
Telephone Number	:	630-573-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 W NORTH AVE STE 402
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1624
Country	:	US
Telephone Number	:	708-450-4551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	06/17/2025

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Directions to “ GENTI MANCO ” Practice Location

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