Provider Demographics
NPI:1689833006
Name:MANIAR, KRUTI PRAFUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KRUTI
Middle Name:PRAFUL
Last Name:MANIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPT. OF PATHOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1057
Mailing Address - Country:US
Mailing Address - Phone:847-570-2182
Mailing Address - Fax:847-570-1938
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1057
Practice Address - Country:US
Practice Address - Phone:847-570-2182
Practice Address - Fax:847-570-1938
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071620207ZP0102X
IL036133123207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD045344700Medicaid
MD045344700Medicaid
MD221456YWBMedicare PIN