MEDICARE: ATREYA MISHRA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629828983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATREYA MISHRA

Provider Business Mailing Address
First Line	:	632 FAIR OAKS AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1738
Country	:	US
Telephone Number	:	773-397-6907
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 FAIR OAKS AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1738
Country	:	US
Telephone Number	:	773-397-6907
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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Directions to “ ATREYA MISHRA ” Practice Location

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