Provider Demographics
NPI:1144375965
Name:MANGAHAS, SUSAN AGUILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:AGUILA
Last Name:MANGAHAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1542 BLUESTEM LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7775
Mailing Address - Country:US
Mailing Address - Phone:847-729-6574
Mailing Address - Fax:847-486-0186
Practice Address - Street 1:1515 E LAKE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-4896
Practice Address - Country:US
Practice Address - Phone:630-830-5926
Practice Address - Fax:630-830-5938
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics