MEDICARE: SHARMITA A MISRA 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	208000000X	Pediatrics Physician	036085278	IL
2	2080N0001X	Neonatal-Perinatal Medicine Physician	036085278	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730171067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARMITA A MISRA MD

Provider Business Mailing Address
First Line	:	1185-87 DUNDEE AVE
Second Line	:	STE A2 ATTN DUNDEE PROFESSIONAL CENTER
City	:	ELGIN
State	:	IL
Zip	:	60120-2232
Country	:	US
Telephone Number	:	847-608-9481
Fax Number	:	847-608-9483

Provider Business Practice Location Address
First Line	:	1185 - 87 DUNDEE AVE
Second Line	:	STE A2 ATTN DUNDEE PROFESSIONAL CENTER
City	:	ELGIN
State	:	IL
Zip	:	60120-2232
Country	:	US
Telephone Number	:	847-608-9481
Fax Number	:	847-608-9483

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	01/16/2013

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