Individual
JANE GRACE MERCADO MANALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
905 MEDICAL PARK DR, EFFINGHAM, IL 62401-2190
(217) 342-2066
(217) 342-2074
Mailing address
905 MEDICAL PARK DR, EFFINGHAM, IL 62401-2190
(217) 342-2066
(217) 342-2074
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036122145
IL
207RH0003X
Hematology & Oncology Physician
84859581-1205
UT
207RX0202X
Medical Oncology Physician
036122145
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88847357001
—
UT
Enumeration date
04/26/2006
Last updated
02/12/2014
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