Provider Demographics
NPI:1912223322
Name:MANN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9711 SKOKIE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1384
Mailing Address - Country:US
Mailing Address - Phone:847-675-9711
Mailing Address - Fax:847-675-9714
Practice Address - Street 1:1450 BUSCH PKWY STE 145
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4541
Practice Address - Country:US
Practice Address - Phone:847-499-5500
Practice Address - Fax:847-499-5501
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2019-12-06
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Provider Licenses
StateLicense IDTaxonomies
IL036-125066207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2485016Medicare PIN