Provider Demographics
NPI:1063585032
Name:MANATT, SAVIO G (MD)
Entity type:Individual
Prefix:DR
First Name:SAVIO
Middle Name:G
Last Name:MANATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20060 GOVERNORS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1099
Mailing Address - Country:US
Mailing Address - Phone:708-283-8300
Mailing Address - Fax:708-283-9245
Practice Address - Street 1:20060 GOVERNORS DR STE 204
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1099
Practice Address - Country:US
Practice Address - Phone:708-283-8300
Practice Address - Fax:708-283-9245
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069553207R00000X
IL036-069553173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-069553Medicaid
IL01623866OtherBLUECROSS BLUESHIELD
IL110215183OtherMEDICARE RAILROAD
IL036-069553Medicaid
ILD16004Medicare UPIN