Provider Demographics
NPI:1124260625
Name:WENGERHOFF, SONIA (MD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:WENGERHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:STERRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2835 N SHEFFIELD AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5081
Mailing Address - Country:US
Mailing Address - Phone:777-334-8830
Mailing Address - Fax:
Practice Address - Street 1:2835 N SHEFFIELD AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:777-334-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361287572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128757Medicaid