Individual
ANTONIO MANCINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
15234 S HARLEM AVE, ORLAND PARK, IL 60462-4330
(708) 888-8287
(708) 614-0607
Mailing address
10400 SOUTHWEST HWY, LL, CHICAGO RIDGE, IL 60415-1367
(708) 888-8287
(708) 274-4027
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-115425
IL
208800000X
Urology Physician
Primary
036-115425
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-115425
MEDICAL LICENSE
IL
05
—
36-115425
—
IL
01
—
IL3265
GROUP PTAN
—
01
—
P00401392
MEDICARE RAILROAD
—
Enumeration date
07/25/2006
Last updated
04/16/2025
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