Provider Demographics
NPI:1134757636
Name:PARK, MONICA K (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:K
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST STE 504
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2613
Mailing Address - Country:US
Mailing Address - Phone:312-826-3627
Mailing Address - Fax:312-926-3231
Practice Address - Street 1:1460 N HALSTED ST STE 504
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2613
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-926-3231
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61439022207Q00000X
IL036176386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine