MEDICARE: DR. SHARA L KRONMAL M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036093149	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	036093149	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001632932	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407898703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARA L KRONMAL M.D., PH.D.

Provider Business Mailing Address
First Line	:	5548 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1714
Country	:	US
Telephone Number	:	773-684-8250
Fax Number	:	773-943-6368

Provider Business Practice Location Address
First Line	:	5548 S KENWOOD AVE
Second Line	:	REAR COACH HOUSE
City	:	CHICAGO
State	:	IL
Zip	:	60637-1714
Country	:	US
Telephone Number	:	773-684-8250
Fax Number	:	773-943-6368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/13/2014

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Directions to “ DR. SHARA L KRONMAL M.D., PH.D.” Practice Location

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