Healthcare Provider Details

I. General information

NPI: 1952475436
Provider Name (Legal Business Name): UMANG SHARMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/07/2023
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5359 W FULLERTON AVE
CHICAGO IL
60639-1450
US

IV. Provider business mailing address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-836-2785
  • Fax: 773-836-7381
Mailing address:
  • Phone: 773-768-5000
  • Fax: 773-768-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036121432
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00045486
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: