# MANTILLA SURGICAL SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477189959
- **Authorized official:** DR. NATHALIE MANTILLA MD (PRESIDENT)
- **Authorized official phone:** (312) 927-5299

## Contact information

- **Practice address:** 42 GALE AVE, RIVER FOREST, IL 60305-2010
- **Practice address phone:** (312) 927-5299
- **Mailing address:** 21200 S LAGRANGE RD STE 322, FRANKFORT, IL 60423-2003
- **Mailing address phone:** (844) 346-8686
- **Mailing address fax:** (844) 427-2845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208C00000X | Colon & Rectal Surgery Physician | — | NULL | Yes |
| 208C00000X | Colon & Rectal Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2020
- **Last updated:** 03/17/2020