Healthcare Provider Details

I. General information

NPI: 1053815944
Provider Name (Legal Business Name): CHERYL ELISE HORNSBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W HARRISON ST
CHICAGO IL
60612
US

IV. Provider business mailing address

1750 W HARRISON ST
CHICAGO IL
60612-3825
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6510
  • Fax:
Mailing address:
  • Phone: 312-942-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125072092
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: