Healthcare Provider Details

I. General information

NPI: 1467769687
Provider Name (Legal Business Name): EMILY SHERBIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N WESTMORELAND RD
LAKE FOREST IL
60045-1659
US

IV. Provider business mailing address

680 N LAKE SHORE DRIVE SUITE 1000
CHICAGO IL
60611-8709
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-5600
  • Fax:
Mailing address:
  • Phone: 312-695-0665
  • Fax: 312-695-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085003750
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.003750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: