Healthcare Provider Details

I. General information

NPI: 1821358029
Provider Name (Legal Business Name): MICHAEL GREGOR SHERENIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 60
CHICAGO IL
60611
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 2000
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6010
  • Fax: 312-227-9401
Mailing address:
  • Phone: 513-636-6771
  • Fax: 513-636-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35.133916
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: