Individual
DIVYA MANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1091
Mailing address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1091
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61180970
WA
390200000X
Student in an Organized Health Care Education/Training Program
125-073178
IL
Other
Enumeration date
06/19/2018
Last updated
02/12/2024
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