Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01052316 | IN |
Y | 207QA0505X | Family Doctor - Adult Medicine | 036085899 | IL |
NPI | 1225084585 |
---|---|
Provider Name | Dr. Carol Hayes-Sharpley |
First Address | Munster, IN 46321-1215 |
Second Address | Chicago, IL 60643-2392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200265760 | (05) | IN |
F88852 | (02) | IN |