1982675310 NPI number — DR. MANALI S AMIN MD

Table of content: BRIAN BAEZ LEON RN (NPI 1982441457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982675310 NPI number — DR. MANALI S AMIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMIN
Provider First Name:
MANALI
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMIN MISHRA
Provider Other First Name:
MANALI
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982675310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 RIDGE AVE STE 1223
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-570-2040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24600 W 127TH ST STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60585-9507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-355-5668
Provider Business Practice Location Address Fax Number:
630-355-2071
Provider Enumeration Date:
02/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  036127893 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 220177 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YP0228X , with the licence number: 036127893 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036127893 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".