Healthcare Provider Details

I. General information

NPI: 1114058617
Provider Name (Legal Business Name): SHERRIFF ALLI-BALOGUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 LINCOLN MALL DR STE 100
MATTESON IL
60443-3812
US

IV. Provider business mailing address

4747 LINCOLN MALL DR STE 100
MATTESON IL
60443-3812
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-8006
  • Fax: 708-747-8272
Mailing address:
  • Phone: 708-747-8006
  • Fax: 708-747-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01051719
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01051719
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: