Organization
DENNIS T MANSHIO MD PHD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS MANSHIO MD PHD (PRESIDENT)
(773) 477-3699
Entity
Organization
Contact information
Practice address
2907 S WABASH AVE STE 100A, CHICAGO, IL 60616-3271
(773) 477-3699
(312) 877-5049
Mailing address
2907 S WABASH AVE STE 100A, CHICAGO, IL 60616-3271
(773) 477-3699
(312) 877-5049
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036065850
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042617097
STATE OF ILLINOIS REGISTERED MEDICAL CORPORATION
IL
Enumeration date
11/17/2010
Last updated
10/30/2024
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