Mancha, Genesis Talia

Mancha, Genesis Talia is an individual health care provider with primary practice located at 1645 W Jackson Blvd Ste 200 , Chicago IL 60612-3227. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Mancha, Genesis Talia can be contacted via phone (312) 942-2200.

Contact Information

Primary practice address
1645 W Jackson Blvd Ste 200 Chicago IL 60612-3227
Phone: (312) 942-2200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 125.077066 Illinois

Profile Details

NPI number 1750905097
LBN Legal business name Mancha, Genesis Talia
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2020
Last updated Jun 12th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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