Organization
BOULEVARD MEDICAL ASSOCIATES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAVIO MANATT M.D. (PRESIDENT)
(708) 754-7777
Entity
Organization
Contact information
Practice address
30 E 15TH ST, SUITE 202, CHICAGO HEIGHTS, IL 60411-3459
(708) 754-7777
(708) 754-7701
Mailing address
30 E 15TH ST, SUITE 202, CHICAGO HEIGHTS, IL 60411-3459
(708) 754-7777
(708) 754-7701
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623866
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/08/2007
Last updated
08/22/2020
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