Provider Demographics
NPI:1851497119
Name:MANIQUIS, VINA MARIA ESTIPONA (MD)
Entity type:Individual
Prefix:DR
First Name:VINA MARIA
Middle Name:ESTIPONA
Last Name:MANIQUIS
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 1:303 EAST PARK AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2898
Mailing Address - Country:US
Mailing Address - Phone:847-522-7505
Mailing Address - Fax:847-522-7504
Practice Address - Street 1:155 NORTH HARBOR DRIVE
Practice Address - Street 2:APARTMENT 5102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-806-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18598Medicare ID - Type Unspecified
ILH07641Medicare UPIN