Active NPI
Mitra Sadrameli
- Oral and Maxillofacial Radiology Dentistry
- Chicago, IL
National Provider Identifier
1871950741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Radiology Dentistry
- License
- 019.030434
- Practice address
- 1201 S Prairie Ave Apt 4901
Chicago, IL 60605-3570 - Phone
- (312) 966-6307
- NPI assigned
- Jan 24, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Radiology Dentistry | 1223X0008X | 019.030434 | IL | Primary |
Addresses
Primary practice location
1201 S Prairie Ave Apt 4901
Chicago, IL 60605-3570
Mailing address
1201 S Prairie Ave Apt 4901
Chicago, IL 60605-3570
Phone (312) 966-6307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019.030434 | Other | IL | STATE OF ILLINOIS, DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030434 | IL | MD | Oral and Maxillofacial Radiology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453593600000",
"number": "1871950741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 S PRAIRIE AVE APT 4901",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606053570",
"telephone_number": "312-966-6307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 S PRAIRIE AVE APT 4901",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606053570",
"telephone_number": "312-966-6307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SADRAMELI",
"first_name": "MITRA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-24",
"last_updated": "2016-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0008X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Radiology",
"state": "IL",
"license": "019.030434",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF ILLINOIS, DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION",
"identifier": "019.030434",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.