Provider Demographics
NPI:1255969168
Name:RALPH, NIKITA SHROFF (MD)
Entity type:Individual
Prefix:DR
First Name:NIKITA
Middle Name:SHROFF
Last Name:RALPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:ASHWIN
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:2535 SOUTH MARTIN LUTHER KING DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-842-7117
Practice Address - Fax:312-326-2102
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-163855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine