Individual
MANISHA J OGALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
45 W 111TH STREET, ROSELAND COMMUNITY HOSPITAL, CHICAGO, IL 60628
(773) 995-3000
(630) 734-1560
Mailing address
15900 S CICERO AVE, OAK FOREST, IL 60452-4006
(708) 633-4292
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036110259
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110259
—
IL
Enumeration date
04/19/2006
Last updated
04/28/2021
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