Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 021002810 | IL |
NPI | 1053824987 |
---|---|
Provider Name | Dr. Manika Agarwal |
First Address | Chicago, IL 60654-8616 |
Second Address | Elmhurst, IL 60126-2780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2017 |
Last Update Date | 21/11/2017 |