Provider Demographics
NPI:1003186479
Name:GIRDHAR, MANIKA (DO)
Entity Type:Individual
Prefix:
First Name:MANIKA
Middle Name:
Last Name:GIRDHAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E 1ST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4247
Mailing Address - Country:US
Mailing Address - Phone:630-323-5522
Mailing Address - Fax:630-323-5524
Practice Address - Street 1:105 E 1ST ST STE 203
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4247
Practice Address - Country:US
Practice Address - Phone:630-323-5522
Practice Address - Fax:630-323-5524
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013849208000000X
IL036136000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics