Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 125070905 | IL |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 87924 | GA |
N | 2081S0010X | Sports Medicine | 87924 | GA |
N | 213ES0000X | Sports Medicine | 87924 | GA |
NPI | 1154852036 |
---|---|
Provider Name | Monica Sheron Branch |
First Address | Chicago, IL 60653-4712 |
Second Address | Chicago, IL 60608-1858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 29/07/2021 |