Provider Demographics
NPI:1508351180
Name:MISHRA, POOJA (MD)
Entity type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:MISHRA
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:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-314-4650
Mailing Address - Fax:
Practice Address - Street 1:7001 ROGERS AVE STE 401A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4034
Practice Address - Country:US
Practice Address - Phone:479-314-4650
Practice Address - Fax:479-452-9459
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-18924207RC0000X, 207RI0011X
OH57.245763207R00000X
390200000X
IL036.156125207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program