Provider Demographics
NPI:1518021047
Name:MUKHERJEE, SOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMA
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-482-0273
Mailing Address - Fax:847-615-1708
Practice Address - Street 1:870 W END CT
Practice Address - Street 2:SUITE 205
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1383
Practice Address - Country:US
Practice Address - Phone:847-362-4155
Practice Address - Fax:847-362-4425
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL336063086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics