MEDICARE: MONICA K PARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD61439022	WA
2	207Q00000X	Family Medicine Physician	036176386	IL

General Provider Information

NPI Number	:	1134757636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA K PARK MD

Provider Business Mailing Address
First Line	:	1460 N HALSTED ST STE 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2613
Country	:	US
Telephone Number	:	312-826-3627
Fax Number	:	312-926-3231

Provider Business Practice Location Address
First Line	:	1460 N HALSTED ST STE 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2613
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:	312-926-3231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	10/14/2025

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