Individual
MANOHAR L JETHANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3635 HARLEM AVE, BERWYN, IL 60402-3212
(708) 447-9402
(708) 447-3246
Mailing address
3635 HARLEM AVE, BERWYN, IL 60402-3212
(708) 447-9402
(708) 447-3246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036046173
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616688
BC/BS PROVIDER #
IL
01
—
036046173
LICENSE #
IL
01
—
14D0857955
CLIA #
IL
Enumeration date
11/01/2006
Last updated
11/03/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us