Individual
MANISH TANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 W GOLF RD STE 105, MOUNT PROSPECT, IL 60056-4276
(847) 439-8780
(847) 439-8940
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036096147
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096147
—
IL
01
—
1616108
BCBS
IL
Enumeration date
07/08/2005
Last updated
04/28/2025
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