Healthcare Provider Details

I. General information

NPI: 1649443375
Provider Name (Legal Business Name): DANIEL KENNETH SHERK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1483
US

IV. Provider business mailing address

3132 W WASHINGTON BLVD
CHICAGO IL
60612-1879
US

V. Phone/Fax

Practice location:
  • Phone: 301-957-3122
  • Fax: 301-498-3074
Mailing address:
  • Phone: 773-354-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0067355
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: