Healthcare Provider Details

I. General information

NPI: 1104316363
Provider Name (Legal Business Name): POOJA B MONPARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W MAXWELL ST FL 2
CHICAGO IL
60607-5001
US

IV. Provider business mailing address

722 W MAXWELL ST FL 2
CHICAGO IL
60607-5001
US

V. Phone/Fax

Practice location:
  • Phone: 412-414-8198
  • Fax:
Mailing address:
  • Phone: 312-996-2901
  • Fax: 312-996-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036157797
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: