Healthcare Provider Details

I. General information

NPI: 1407194780
Provider Name (Legal Business Name): WELL BABY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185-87 DUNDEE AVENUE SUITE A-2
ELGIN IL
60120
US

IV. Provider business mailing address

1185-87 DUNDEE AVENUE SUITE A-2
ELGIN IL
60120
US

V. Phone/Fax

Practice location:
  • Phone: 847-608-9481
  • Fax: 847-608-9483
Mailing address:
  • Phone: 847-608-9481
  • Fax: 847-608-9483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-085278
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-085278
License Number StateIL

VIII. Authorized Official

Name: SHARMITA A MISRA
Title or Position: PHYSICIAN, OWNER
Credential: M.D.
Phone: 847-608-9481