Individual
DR. MANJESHWAR B. PRABHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1730 E LAKE SHORE DR STE 301, DECATUR, IL 62521-3809
(217) 329-1000
(217) 329-1055
Mailing address
1770 E LAKE SHORE DR, SUITE 301, DECATUR, IL 62521-3832
(217) 464-1350
(217) 464-1359
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036083999
IL
207RP1001X
Pulmonary Disease Physician
Primary
036-083999
IL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
036083999
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083999
—
IL
Enumeration date
09/23/2006
Last updated
01/03/2022
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