Provider Demographics
NPI:1669487146
Name:VIRANI, MANSOOR (DPM)
Entity Type:Individual
Prefix:
First Name:MANSOOR
Middle Name:
Last Name:VIRANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 N ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1419
Mailing Address - Country:US
Mailing Address - Phone:630-279-7703
Mailing Address - Fax:630-279-7704
Practice Address - Street 1:638 N ADDISON RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-1419
Practice Address - Country:US
Practice Address - Phone:630-279-7703
Practice Address - Fax:630-279-7704
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-04581213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1669487146OtherNPI