Provider Demographics
NPI:1871997650
Name:MANI-SANA, S.C.
Entity type:Organization
Organization Name:MANI-SANA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSALINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUNTEAN-MINCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-828-3594
Mailing Address - Street 1:1124 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2923
Mailing Address - Country:US
Mailing Address - Phone:847-405-9822
Mailing Address - Fax:
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 525
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-769-1400
Practice Address - Fax:773-334-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty