Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Annie Mannancheril

Individual provider Physician Assistant · NPI 1306450424

Annie Mannancheril is a Physician Assistant in Morton Grove, Illinois. Qualified in 2020, 6 years ago. Practices with Divinity Medical Services PLLC, a 93-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
6
Licensed in
NY
In the registry since
2020
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Practice location Address checks out

9114 Waukegan Rd
Morton Grove, IL 60053-2135
Phone: (000) 000-0000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 025541 (NY)

Record details

NPI number1306450424
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 4, 2020
Last updated in NPPESSeptember 4, 2020
Certification dateSeptember 4, 2020
Mailing address9114 Waukegan Rd, Morton Grove, IL 60053-2135

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Divinity Medical Services Pllc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

Other providers in Morton Grove