Healthcare Provider Details

I. General information

NPI: 1790770659
Provider Name (Legal Business Name): SHUBHRA MUKHERJEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N OAK PARK AVE
CHICAGO IL
60707-3392
US

IV. Provider business mailing address

PO BOX 8500
PHILADELPHIA PA
19178-8500
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-5463
  • Fax: 773-385-5488
Mailing address:
  • Phone: 773-385-5463
  • Fax: 773-385-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-102847
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-102847
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number036-102847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: