Healthcare Provider Details

I. General information

NPI: 1972696391
Provider Name (Legal Business Name): SHEREE L. PEGLOW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MICHIGAN ST STE 314
SOUTH BEND IN
46601-1070
US

IV. Provider business mailing address

707 N MICHIGAN ST STE 314
SOUTH BEND IN
46601-1070
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-5938
  • Fax:
Mailing address:
  • Phone: 574-234-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number50004043
License Number StateIN

VIII. Authorized Official

Name: SHEREE L. PEGLOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 574-234-5938