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General NPI Number Information
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NPI Number | 1104050038
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Entity Type | Organization
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Legal Business Name | SHERMAN PHYSICIAN GROUP, INC
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 1000 S STATE ST
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City | HAMPSHIRE
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State | IL
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Zip | 60140-9688
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Country | US
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Telephone | 847-683-7543
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Fax | 847-683-7537
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Provider Business Mailing Address
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Address Line | PO BOX 1509
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City | ELGIN
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State | IL
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Zip | 60121-1509
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Country | US
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Telephone | 224-238-4160
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Fax | 847-783-0599
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | KATHLEEN UTECH
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Credential |
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Telephone | 224-783-5196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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