MEDICARE: SANDRA MARIE PENA MD

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	207Q00000X	Family Medicine Physician	036.150456	IL

General Provider Information

NPI Number	:	1932563996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MARIE PENA MD

Provider Business Mailing Address
First Line	:	932 LAKE ST STE 300
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1204
Country	:	US
Telephone Number	:	331-221-1700
Fax Number	:	331-221-2729

Provider Business Practice Location Address
First Line	:	932 LAKE ST STE 300
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1204
Country	:	US
Telephone Number	:	331-221-1700
Fax Number	:	331-221-2729

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

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	09/28/2023

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