Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 036-090899 | IL |
NPI | 1396739280 |
---|---|
Provider Name | Dr. Sonya M Sharpless |
First Address | Lake Forest, IL 60045-1659 |
Second Address | Lake Forest, IL 60045-1659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 03/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G79570 | (02) |