Basic Information
| Provider Information | |||||||||
| NPI: | 1144543992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANOHAR | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | MURLI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 W. PARK ST. | ||||||||
| Address2: | BWPC | ||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173836792 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 810 W. ANTHONY DR. | ||||||||
| Address2: | ORTHO | ||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618027431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173262255 | ||||||||
| FaxNumber: | 2173260210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2010 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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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 | 207X00000X | 056405405104 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 036137921 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.