Individual
AVINASH MANTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3046 127TH ST, BLUE ISLAND, IL 60406-1827
(708) 377-7920
(708) 930-0414
Mailing address
3046 127TH ST, BLUE ISLAND, IL 60406-1827
(708) 377-7920
(708) 930-0414
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036147326
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/14/2014
Last updated
10/30/2018
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