Healthcare Provider Details

I. General information

NPI: 1255418703
Provider Name (Legal Business Name): THOMAS G SHEAGREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

2769 SIOUX TRL
GLENVIEW IL
60026-1043
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-5313
  • Fax: 847-723-2338
Mailing address:
  • Phone: 847-272-0637
  • Fax: 857-723-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-05555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: