Provider Demographics
NPI:1316568207
Name:SEJPAL, MANASI (MBBS)
Entity Type:Individual
Prefix:
First Name:MANASI
Middle Name:
Last Name:SEJPAL
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 S CICERO AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6458
Mailing Address - Country:US
Mailing Address - Phone:708-636-7575
Mailing Address - Fax:
Practice Address - Street 1:10837 S CICERO AVE FL 2
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6458
Practice Address - Country:US
Practice Address - Phone:708-636-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2024-03-26
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-04-06
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.165397207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program