Healthcare Provider Details

I. General information

NPI: 1790960078
Provider Name (Legal Business Name): VANESSA SARDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 W DIVISION ST
CHICAGO IL
60622-2942
US

IV. Provider business mailing address

1040 SIERRA DR SUITE 400
GREENWOOD IN
46143-7240
US

V. Phone/Fax

Practice location:
  • Phone: 773-486-8820
  • Fax: 773-486-8823
Mailing address:
  • Phone: 317-528-4881
  • Fax: 219-934-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-120446
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01066516A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-120446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: