Basic Information
| Provider Information | |||||||||
| NPI: | 1104022623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANRIQUE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 W FILLMORE ST UNIT 3 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606074615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126664879 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 N CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606143363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738804000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.