=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760513725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREG E SHARON MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 E ARMY TRAIL RD STE 403
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-894-7083
-----------------------------------------------------
Fax | 630-894-9472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 E ARMY TRAIL RD STE 403
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-894-7083
-----------------------------------------------------
Fax | 630-894-9472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREG SHARON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 630-894-7083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------