Individual
AUGUSTINE MANADAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1725 W HARRISON ST, SUITE 1017, CHICAGO, IL 60612-3841
(312) 942-6641
Mailing address
1611W HARRISON ST 510, CHICAGO, IL 60612-4861
(312) 563-2800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-100913
IL
207RR0500X
Rheumatology Physician
Primary
036-100913
IL
Other
Enumeration date
07/13/2006
Last updated
04/27/2021
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