Healthcare Provider Details

I. General information

NPI: 1023389020
Provider Name (Legal Business Name): SHARON KOBAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 S. INDIANA AVE. UNIT A1
CHICAGO IL
60616-1376
US

IV. Provider business mailing address

1616 S. INDIANA AVE. UNIT A1
CHICAGO IL
60616-1376
US

V. Phone/Fax

Practice location:
  • Phone: 312-235-0911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036049714
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: