Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036067184 | IL |
N | 207KA0200X | Allergist | 036067184 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036067184 | IL |
NPI | 1619950250 |
---|---|
Provider Name | Dr. Greg Edward Sharon |
First Address | Bloomingdale, IL 60108-2169 |
Second Address | Bloomingdale, IL 60108-2169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 01/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0280127 | UNITED (01) | IL |
0300003362 | RAILROAD MEDICARE (01) | IL |
036067184 | (05) | IL |
2215630 | BCBS (01) | IL |
363765151 | FEIN (01) | IL |
5254328 | AETNA (01) | IL |
C48645 | (02) | IL |