Provider Demographics
NPI:1497752703
Name:MANAM, SATYA P (MD)
Entity Type:Individual
Prefix:
First Name:SATYA
Middle Name:P
Last Name:MANAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5504
Mailing Address - Country:US
Mailing Address - Phone:815-748-8993
Mailing Address - Fax:
Practice Address - Street 1:626 BETHANY RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4939
Practice Address - Country:US
Practice Address - Phone:815-748-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088418207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088418Medicaid
ILG15624Medicare UPIN
IL206595Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK02442Medicare UPIN