Provider Demographics
NPI:1679745210
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 1:32 W NEBRASKA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1800
Mailing Address - Country:US
Mailing Address - Phone:815-464-5986
Mailing Address - Fax:815-806-8756
Practice Address - Street 1:15505 E 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4433
Practice Address - Country:US
Practice Address - Phone:630-243-8888
Practice Address - Fax:630-257-2664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANHATTAN MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
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
IL209583OtherMEDICARE
IL0360916351Medicaid
IL209583OtherMEDICARE