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DR. MITRA SADRAMELI

Oral and Maxillofacial Radiology

Chicago, Illinois

Provider NPI: 1871950741

Provider Information:
DR. MITRA  SADRAMELI 
Gender: F
Sole Proprietor


Practice Location:
1201 S PRAIRIE AVE APT 4901  CHICAGO, IL 60605 US
Tel: 312-966-6307  Fax: --

Business Mailing Address:
1201 S PRAIRIE AVE APT 4901  CHICAGO, IL 60605 US
Tel: 312-966-6307  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223X0008XDental Providers
Dentist
Oral and Maxillofacial Radiology
IL019.030434

Other Provider Identifiers:

IssuerNumberStateType
STATE OF ILLINOIS, DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION019.030434IL01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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