Organization
MANTILLA SURGICAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHALIE MANTILLA MD (PRESIDENT)
(312) 927-5299
Entity
Organization
Contact information
Practice address
42 GALE AVE, RIVER FOREST, IL 60305-2010
(312) 927-5299
Mailing address
21200 S LAGRANGE RD STE 322, FRANKFORT, IL 60423-2003
(844) 346-8686
(844) 427-2845
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
—
—
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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