Healthcare Provider Details

I. General information

NPI: 1043586712
Provider Name (Legal Business Name): MS. ANPHY MOHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE, UNIVERSITY OF CHICAGO MEDICAL CENTER DEPT. OF OB/GYN
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5841 S MARYLAND AVE UNIVERSITY OF CHICAGO MEDICAL CENTER
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax: 773-702-5411
Mailing address:
  • Phone: 773-702-1000
  • Fax: 773-702-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004278
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: