Healthcare Provider Details

I. General information

NPI: 1104050038
Provider Name (Legal Business Name): SHERMAN PHYSICIAN GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S STATE ST
HAMPSHIRE IL
60140-9688
US

IV. Provider business mailing address

PO BOX 1509
ELGIN IL
60121-1509
US

V. Phone/Fax

Practice location:
  • Phone: 847-683-7543
  • Fax: 847-683-7537
Mailing address:
  • Phone: 224-238-4160
  • Fax: 847-783-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: KATHLEEN UTECH
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 224-783-5196