Mantilla Surgical SC

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

Legal business name

MANTILLA SURGICAL SC

Practice address

42 Gale Ave
River Forest, IL 60305-2010

Phone

(312) 927-5299

NPI assigned

Mar 17, 2020

Last updated

Mar 17, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nathalie Mantilla, MD

Title

President

Phone

(312) 927-5299

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1477189959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21200 S LAGRANGE RD STE 322",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604232003",
            "telephone_number": "844-346-8686",
            "fax_number": "844-427-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 GALE AVE",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603052010",
            "telephone_number": "312-927-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTILLA SURGICAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-17",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "MANTILLA",
        "authorized_official_first_name": "NATHALIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-927-5299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frances E Lynch
• John Lynch
• Sheila E Lynch
• Jordan Lynn, ATC
• Bernardo Mangilin
• Mark Tomera MC
• Markovic Medical Inc
• Gary Marshall Mart, M.D.
• Barbara Martin, MA CCC-SLP
• Mary L. Kelly, D.O., S.C.

• Colon & Rectal Surgery Physician in River Forest, IL
• Providers in River Forest, IL by specialty
• Colon & Rectal Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.