Healthcare Provider Details

I. General information

NPI: 1730171067
Provider Name (Legal Business Name): SHARMITA A MISRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 - 87 DUNDEE AVE STE A2 ATTN DUNDEE PROFESSIONAL CENTER
ELGIN IL
60120-2232
US

IV. Provider business mailing address

1185-87 DUNDEE AVE STE A2 ATTN DUNDEE PROFESSIONAL CENTER
ELGIN IL
60120-2232
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 Number036085278
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036085278
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: