Provider Demographics
NPI:1932563996
Name:PENA, SANDRA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:PENA
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 1:932 LAKE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1204
Mailing Address - Country:US
Mailing Address - Phone:331-221-1700
Mailing Address - Fax:331-221-2729
Practice Address - Street 1:932 LAKE ST STE 300
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1204
Practice Address - Country:US
Practice Address - Phone:331-221-1700
Practice Address - Fax:331-221-2729
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.150456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine