=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780979401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANN SHERROW MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2011
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 RANDALL RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-208-4060
-----------------------------------------------------
Fax | 630-208-4401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1207 BOSWELL LN
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-208-4060
-----------------------------------------------------
Fax | 630-208-4401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 036136871
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------