Provider Demographics
NPI:1982009924
Name:DUPAGE ENT, LLC
Entity Type:Organization
Organization Name:DUPAGE ENT, LLC
Other - Org Name:DUPAGE CHILDREN'S ENT & ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANALI
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-785-0367
Mailing Address - Street 1:1331 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9310
Mailing Address - Country:US
Mailing Address - Phone:630-761-5531
Mailing Address - Fax:
Practice Address - Street 1:1331 W 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9310
Practice Address - Country:US
Practice Address - Phone:630-761-5531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8874117207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1982675310OtherCMS