Provider Demographics
NPI:1598808735
Name:MANHATTAN MEDICAL
Entity Type:Organization
Organization Name:MANHATTAN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BADESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-464-5986
Mailing Address - Street 1:440 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-8504
Mailing Address - Country:US
Mailing Address - Phone:847-429-0571
Mailing Address - Fax:847-429-0570
Practice Address - Street 1:440 S STATE ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-8504
Practice Address - Country:US
Practice Address - Phone:847-429-0571
Practice Address - Fax:847-429-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091635173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360916351Medicaid
IL14D0976033OtherCLIA
IL0009932128OtherBC/BS
IL0009932128OtherBC/BS
IL209583Medicare ID - Type Unspecified
IL14D0976033OtherCLIA
ILG36109Medicare UPIN