Healthcare Provider Details

I. General information

NPI: 1679992093
Provider Name (Legal Business Name): AISHA SOZZER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST DEPT OF
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

5444 SUFFIELD TER
SKOKIE IL
60077-1174
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-5524
  • Fax: 847-723-3532
Mailing address:
  • Phone: 847-322-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125065033
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036-145918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: