Provider Demographics
NPI:1902002439
Name:WENTWORTH, MONICA PRISCILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:PRISCILLA
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:820 S WOOD ST
Mailing Address - Street 2:SUITE 515 CLINICAL SCIENCE NORTH BUILDING (M/C 958)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-9313
Mailing Address - Fax:
Practice Address - Street 1:820 S WOOD ST
Practice Address - Street 2:SUITE 515 CLINICAL SCIENCE NORTH BUILDING (M/C 958)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036126893208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery