Provider Demographics
NPI:1760791156
Name:REILLY, SUPNA OBEROI
Entity Type:Individual
Prefix:DR
First Name:SUPNA
Middle Name:OBEROI
Last Name:REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUPNA
Other - Middle Name:
Other - Last Name:OBEROI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:740 W FULTON ST
Mailing Address - Street 2:#1302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5000
Mailing Address - Country:US
Mailing Address - Phone:508-259-8466
Mailing Address - Fax:
Practice Address - Street 1:4805 N CLAREMONT AVE
Practice Address - Street 2:COMMERCIAL UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1909
Practice Address - Country:US
Practice Address - Phone:312-579-3150
Practice Address - Fax:312-579-3151
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005494213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery