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Individual

AMRIT MANGAT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
430 PENNSYLVANIA AVE, SUITE 350, GLEN ELLYN, IL 60137-4464
(630) 790-1700
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036-102386
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036102386
IL
01
P00749996
RR MEDICARE
IL
Enumeration date
02/19/2007
Last updated
12/23/2019
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