Provider Demographics
NPI:1902254592
Name:MANIAR, ANUM FAHAD
Entity Type:Individual
Prefix:
First Name:ANUM
Middle Name:FAHAD
Last Name:MANIAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANUM
Other - Middle Name:ZAHID
Other - Last Name:MANIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3814
Mailing Address - Country:US
Mailing Address - Phone:630-978-9754
Mailing Address - Fax:630-978-2709
Practice Address - Street 1:400 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3814
Practice Address - Country:US
Practice Address - Phone:630-978-9754
Practice Address - Fax:630-978-2709
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056904207Q00000X
IL036150319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine