Healthcare Provider Details

I. General information

NPI: 1790758894
Provider Name (Legal Business Name): MICHAEL EDWIN SHEEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

IV. Provider business mailing address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

V. Phone/Fax

Practice location:
  • Phone: 217-483-3487
  • Fax: 217-483-8150
Mailing address:
  • Phone: 217-483-3487
  • Fax: 217-483-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: