Individual
SHWETHA MANJUNATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
304 RANDALL RD, GENEVA, IL 60134-4200
(630) 262-8554
(630) 208-7363
Mailing address
700 COMMERCE DR STE 500, OAK BROOK, IL 60523-8736
(847) 698-0600
(847) 698-0601
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036158938
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036158938
ILLINOIS STATE LICENSE
IL
Enumeration date
05/10/2017
Last updated
08/02/2022
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