Provider Demographics
NPI:1154595890
Name:MANFREDINI, ROBERT JOHN JR (DN)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:MANFREDINI
Suffix:JR
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-1824
Mailing Address - Country:US
Mailing Address - Phone:847-533-7404
Mailing Address - Fax:847-865-5300
Practice Address - Street 1:363 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1824
Practice Address - Country:US
Practice Address - Phone:847-533-7404
Practice Address - Fax:847-865-5300
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000286172P00000X
IL181-000286172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath