Healthcare Provider Details

I. General information

NPI: 1134243942
Provider Name (Legal Business Name): SHELDON S. GREENBERG, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 NORTH SHEFFIELD AVE. SUITE 200
CHICAGO IL
60657-5083
US

IV. Provider business mailing address

2835 NORTH SHEFFIELD AVE. SUITE 200
CHICAGO IL
60657-5083
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-3365
  • Fax: 773-880-2409
Mailing address:
  • Phone: 773-561-3365
  • Fax: 773-880-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number036042726
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036042726
License Number StateIL

VIII. Authorized Official

Name: DR. SHELDON STUART GREENBERG
Title or Position: OWNER
Credential: M.D.
Phone: 773-561-3365