Provider Demographics
NPI:1427105022
Name:MANTE, JOSEPHINE (MD)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:MANTE
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 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1451
Mailing Address - Country:US
Mailing Address - Phone:630-897-9606
Mailing Address - Fax:630-897-9625
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-897-9606
Practice Address - Fax:630-897-9625
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088055207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001630376OtherBLUE CROSS BLUE SHIELD
F98616Medicare UPIN
ILL91485Medicare PIN