Provider Demographics
NPI:1407898703
Name:KRONMAL, SHARA L (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARA
Middle Name:L
Last Name:KRONMAL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 S KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1714
Mailing Address - Country:US
Mailing Address - Phone:773-684-8250
Mailing Address - Fax:773-943-6368
Practice Address - Street 1:5548 S KENWOOD AVE
Practice Address - Street 2:REAR COACH HOUSE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1714
Practice Address - Country:US
Practice Address - Phone:773-684-8250
Practice Address - Fax:773-943-6368
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360931492084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632932OtherBLUE CROSS BLUE SHIELD
IL036093149Medicaid
IL0001632932OtherBLUE CROSS BLUE SHIELD