Individual
DR. MARLENE MANTICH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
7722 S KEDZIE AVE, CHICAGO, IL 60652-1915
(312) 919-9783
Mailing address
PO BOX 14147, CHICAGO, IL 60614-0147
(312) 919-9783
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004721-1
—
IL
01
—
01606975
BLUE SHIELD
IL
Enumeration date
05/26/2006
Last updated
07/08/2007
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