Individual
MANUEL R ASCANO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 PARK AVE E, PRINCETON, IL 61356-2537
(815) 875-4531
(815) 876-2118
Mailing address
530 PARK AVE E, PRINCETON, IL 61356-3901
(815) 875-2811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036073015
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073015
—
IL
05
—
0360730154
—
IL
01
—
P00219992
RAILROAD MEDICARE
IL
Enumeration date
05/28/2006
Last updated
10/13/2020
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