Healthcare Provider Details

I. General information

NPI: 1396992400
Provider Name (Legal Business Name): SONYA NICHOLE EPHRAIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21660 W FIELD PKWY STE 201
DEER PARK IL
60010-7265
US

IV. Provider business mailing address

21660 W FIELD PKWY STE 201
DEER PARK IL
60010-7265
US

V. Phone/Fax

Practice location:
  • Phone: 847-807-3633
  • Fax: 847-787-1546
Mailing address:
  • Phone: 847-807-3633
  • Fax: 847-787-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036126372
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD451794
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036126372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: