Healthcare Provider Details

I. General information

NPI: 1932109337
Provider Name (Legal Business Name): ROBERT E SHARE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 SOUTHWEST HWY LOWER LEVEL
CHICAGO RIDGE IL
60415-1367
US

IV. Provider business mailing address

10400 SOUTHWEST HWY LOWER LEVEL
CHICAGO RIDGE IL
60415-1367
US

V. Phone/Fax

Practice location:
  • Phone: 708-581-7308
  • Fax: 708-581-7309
Mailing address:
  • Phone: 708-581-7308
  • Fax: 708-581-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036076990
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: