Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 036-093168 | IL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036-093168 | IL |
NPI | 1174619753 |
---|---|
Provider Name | Dr. Evan T. Manolis |
First Address | Orland Park, IL 60462-5395 |
Second Address | Orland Park, IL 60462-5395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036093168 | (05) | IL |
G74934 | (02) | IL |