Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036.147464 | IL |
Y | 111NI0900X | Internist | 036.147464 | IL |
N | 207R00000X | Internist | 4301095446 | MI |
N | 111NI0900X | Internist | 4301095446 | MI |
NPI | 1003143231 |
---|---|
Provider Name | Dr. Mandy Luma Enshiwat |
First Address | Oak Lawn, IL 60453-4805 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2009 |
Last Update Date | 20/12/2021 |