Provider Demographics
NPI:1982675310
Name:AMIN, MANALI S (MD)
Entity Type:Individual
Prefix:DR
First Name:MANALI
Middle Name:S
Last Name:AMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANALI
Other - Middle Name:S
Other - Last Name:AMIN MISHRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1331 W 75TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 W 75TH ST
Practice Address - Street 2:STE 302
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:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220177207Y00000X
IL036127893207Y00000X
IL036.127893207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127893Medicaid