Healthcare Provider Details

I. General information

NPI: 1275282972
Provider Name (Legal Business Name): SIDRA MAMSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

1725 W HARRISON ST STE 1106
CHICAGO IL
60612-3845
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone: 312-563-4234
  • Fax: 312-942-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036180117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: