1255318879 NPI number — MARIA SOBRERO MD

Table of content: MARIA SOBRERO MD (NPI 1255318879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255318879 NPI number — MARIA SOBRERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBRERO
Provider First Name:
MARIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255318879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 S DESPLAINES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60661-5500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-654-2700
Provider Business Mailing Address Fax Number:
312-654-9930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 S KING DR
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-379-8022
Provider Business Practice Location Address Fax Number:
312-674-4001
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  036072521 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036072521 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01615184 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com