Basic Information
| Provider Information | |||||||||
| NPI: | 1881186534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANNHEIM | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PEDIATRIC INFECTIOUS DISEASES | ||||||||
| Address2: | 5841 S. MARYLAND AVENUE M/C 6054 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60637 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | PEDIATRIC INFECTIOUS DISEASES | ||||||||
| Address2: | 5841 S. MARYLAND AVENUE M/C 6054 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737026169 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2018 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036.155211 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0208X | 036.155211 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 036.155211 | 01 | IL | DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION | OTHER |