Provider Demographics
NPI:1821655663
Name:MEDRANO, MONICA (MD, MS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 N ASHLAND AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2004
Mailing Address - Country:US
Mailing Address - Phone:773-807-1110
Mailing Address - Fax:
Practice Address - Street 1:3012 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6144
Practice Address - Country:US
Practice Address - Phone:219-877-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.158389207Q00000X
IN01088219A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine