Individual
GENTI MANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
675 W NORTH AVE STE 402, MELROSE PARK, IL 60160-1624
(708) 450-4551
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014660
IL
Other
Enumeration date
08/03/2016
Last updated
06/17/2025
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