Melissa E Manke, FNP
Individual provider Active NPI Family Medicine Physician · Fox River Grove, IL
NPI 1295582591 · NPPES record last updated May 3, 2024
Key facts
- NPI
- 1295582591
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 209.029618 (IL)
- Practice address
- 912 Northwest Hwy Ste 206
Fox River Grove, IL 60021-1925 - Phone
- (847) 516-8187
- Fax
- (847) 516-8235
- NPI assigned
- May 3, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.029618 | IL | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 209.029618 | IL | Yes |
Addresses
Primary practice location
912 Northwest Hwy Ste 206
Fox River Grove, IL 60021-1925
Mailing address
2819 Raycraft Rd
Woodstock, IL 60098-8305
Phone (815) 790-8019
Other providers in Fox River Grove, IL
- Chloe Latka
- Jacquelyn Lebreck
- Eunice E Lee
- Anna Marie Lincheck
- Carol Main-Benner
- Vanessa Manzo
- Jeri Nichole McVey
- Carrie McWilliams
- Michael Reilly M.D. Holistic & Family Practice Medicine LTD
- Josephine H Mo
All providers in Fox River Grove, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.