Provider Demographics
NPI:1700921699
Name:MANUS, DEBORAH C (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:C
Last Name:MANUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LAKE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1135
Mailing Address - Country:US
Mailing Address - Phone:708-524-8600
Mailing Address - Fax:708-524-8147
Practice Address - Street 1:1010 W LAKE ST STE 500
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1135
Practice Address - Country:US
Practice Address - Phone:708-524-8600
Practice Address - Fax:708-524-8147
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00222165OtherRAILROAD MEDICARE
ILF08461Medicare UPIN
ILK12242Medicare ID - Type Unspecified