Healthcare Provider Details

I. General information

NPI: 1497972640
Provider Name (Legal Business Name): SHERI DEWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 DELNOR DR
GENEVA IL
60134
US

IV. Provider business mailing address

25 N WINFIELD RD
WINFIELD IL
60190
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax:
Mailing address:
  • Phone: 630-933-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036.131019
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: