Organization
MANUEL CESAR IGLESIAS, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL C. IGLESIAS M.D. (PRESIDENT)
(847) 967-1149
Entity
Organization
Contact information
Practice address
1111 SUPERIOR ST, SUITE 409, MELROSE PARK, IL 60160-4138
(708) 681-0070
Mailing address
8135 N MILWAUKEE AVE, NILES, IL 60714-2828
(847) 967-1149
(847) 967-8594
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21607825
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
06/01/2006
Last updated
10/01/2007
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