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:
Health care specialties
| Specialty | Code | License # | 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 6 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710936497 | NPPES |
| Illinois | MEDICAID | 036099816 | |
| Illinois | Other | 212545 | |
| Illinois | Other | 202926 |
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