Individual
LUIS A MANRIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-5518
(630) 933-4168
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-5518
(630) 933-4168
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036110692
IL
207RI0200X
Infectious Disease Physician
Primary
036110692
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110692
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
—
01
—
CA4748
MEDICARE RAILROAD (GROUP)
—
01
—
P00924096
MEDICARE RAILROAD (PROVIDER)
—
01
—
T01421
MEDICARE PTAN (INDIVIDUAL)
—
Enumeration date
07/16/2006
Last updated
05/14/2013
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