Manness, Wayne Kenneth

Manness, Wayne Kenneth is an individual health care provider with primary practice located at 530 Ne Glen Oak Ave , Peoria IL 61637-0914. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Manness, Wayne Kenneth can be contacted via phone (309) 655-2000.

Contact Information

Primary practice address
530 Ne Glen Oak Ave Peoria IL 61637-0914
Phone: (309) 655-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 0101242387 Virginia
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 35.091090 Ohio
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X D00661190 Maryland
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 25MA06727700 New Jersey
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD057715L Pennsylvania
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 036-099816 Illinois

Profile Details

NPI number 1710936497
LBN Legal business name Manness, Wayne Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 9th, 2006
Last updated Mar 19th, 2024 - about 2 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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Identifiers

StateTypeNumberIssuer
All States NPI 1710936497 NPPES
Illinois MEDICAID 036099816
Illinois Other 212545
Illinois Other 202926

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