Provider Demographics
NPI:1194952614
Name:SHARMA, CHANDRA (MD)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 JOLIET RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7431
Mailing Address - Country:US
Mailing Address - Phone:847-873-9367
Mailing Address - Fax:224-246-8127
Practice Address - Street 1:6335 JOLIET RD STE 104
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-7431
Practice Address - Country:US
Practice Address - Phone:847-873-9367
Practice Address - Fax:224-246-8127
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine