Individual
DR. WAYNE KENNETH MANNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0914
(309) 655-2000
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101242387
VA
2085R0202X
Diagnostic Radiology Physician
Primary
036-099816
IL
2085R0202X
Diagnostic Radiology Physician
25MA06727700
NJ
2085R0202X
Diagnostic Radiology Physician
35.091090
OH
2085R0202X
Diagnostic Radiology Physician
D00661190
MD
2085R0202X
Diagnostic Radiology Physician
MD057715L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036099816
—
IL
01
—
202926
GROUP PTAN
IL
01
—
212545
GROUP PTAN
IL
Enumeration date
05/09/2006
Last updated
03/19/2024
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