Healthcare Provider Details

I. General information

NPI: 1730171067
Provider Name (Legal Business Name): SHARMITA A MISRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8321 W GOLF RD
NILES IL
60714-1113
US

IV. Provider business mailing address

6301 N WESTERN AVE
CHICAGO IL
60659-2009
US

V. Phone/Fax

Practice location:
  • Phone: 847-720-3511
  • Fax:
Mailing address:
  • Phone: 773-761-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036085278
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036085278
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: