Healthcare Provider Details

I. General information

NPI: 1841685765
Provider Name (Legal Business Name): SNEHAL SHANKAR SONAWANE MBBS DNB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SNEHAL SHINDE MBBS DNB

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST RM 130CSN
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

530 N LAFAYETTE BLVD
SOUTH BEND IN
46601-1004
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7312
  • Fax: 312-996-7586
Mailing address:
  • Phone: 574-234-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number036.146365
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number036146365
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01084417A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.025438
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036146365
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: