Healthcare Provider Details

I. General information

NPI: 1851332902
Provider Name (Legal Business Name): ANDREI SHARAPOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/27/2023
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. MARY OF NAZARETH HOSPITAL / ANESTHESIA DEPT. 2233 W. DIVISION STREET
CHICAGO IL
60622
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2000
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax: 630-874-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036108572
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: