Provider Demographics
NPI:1679099626
Name:DHINGRA, MANAN (MD)
Entity type:Individual
Prefix:
First Name:MANAN
Middle Name:
Last Name:DHINGRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST STE P320
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3490
Mailing Address - Country:US
Mailing Address - Phone:815-928-5064
Mailing Address - Fax:815-928-5065
Practice Address - Street 1:375 N WALL ST STE P320
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3490
Practice Address - Country:US
Practice Address - Phone:815-928-5064
Practice Address - Fax:815-928-5065
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP8082207R00000X
IL036172994207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine