Healthcare Provider Details

I. General information

NPI: 1730876962
Provider Name (Legal Business Name): CHERISHMA NAGISETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 W CERMAK RD
NORTH RIVERSIDE IL
60546-1405
US

IV. Provider business mailing address

7503 W CERMAK RD
NORTH RIVERSIDE IL
60546-1405
US

V. Phone/Fax

Practice location:
  • Phone: 708-484-6338
  • Fax: 708-442-9863
Mailing address:
  • Phone: 708-484-6338
  • Fax: 708-442-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036178815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: