Healthcare Provider Details

I. General information

NPI: 1083612873
Provider Name (Legal Business Name): SHARON J BONDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST
DECATUR IL
62526-4163
US

IV. Provider business mailing address

724 CRYSTAL CT
DECATUR IL
62526-9280
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-8121
  • Fax:
Mailing address:
  • Phone: 217-877-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-041151
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: