Healthcare Provider Details

I. General information

NPI: 1477710788
Provider Name (Legal Business Name): MONICA SHARMA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR SUITE 1231
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

2900 N LAKE SHORE DR SUITE 1231
CHICAGO IL
60657-5640
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3261
  • Fax: 773-665-9435
Mailing address:
  • Phone: 773-665-3261
  • Fax: 773-665-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number11013735A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-116541
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-116541
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036116541
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036116541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: