Individual
ELIZABETH NICOLE MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MB BCH BAO
Contact information
Practice address
5841 S MARYLAND AVE # MC1145, CHICAGO, IL 60637-1443
(773) 702-3020
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
036.165352
IL
Other
Enumeration date
06/02/2020
Last updated
06/29/2023
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