Healthcare Provider Details

I. General information

NPI: 1033977871
Provider Name (Legal Business Name): MOHINI PRASHANT GHARPURE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S WOLCOTT AVE
CHICAGO IL
60612-3748
US

IV. Provider business mailing address

369 W GRAND AVE APT 1701
CHICAGO IL
60654-4543
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125.085974
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: