Provider Demographics
NPI:1487706412
Name:LAFITA, MANUEL H (MD)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:H
Last Name:LAFITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2825
Mailing Address - Country:US
Mailing Address - Phone:773-725-3348
Mailing Address - Fax:773-725-3235
Practice Address - Street 1:4040 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2825
Practice Address - Country:US
Practice Address - Phone:773-725-3348
Practice Address - Fax:773-725-3235
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03636250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03636250Medicaid
0162988270OtherBCBS
IL03636250Medicaid
IL44300Medicare ID - Type Unspecified