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General NPI Number Information
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NPI Number | 1992980627
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Entity Type | Organization
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Legal Business Name | PHILIP H SHERIDAN JR SC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 2650 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60201-1718
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Country | US
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Telephone | 847-657-1960
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Fax | 847-446-1893
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Provider Business Mailing Address
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Address Line | PO BOX 616
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City | FOREST PARK
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State | IL
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Zip | 60130-0616
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Country | US
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Telephone | 708-366-7177
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Fax | 708-366-3301
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP H SHERIDAN JR.
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Credential | M.D.
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Telephone | 847-774-7836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036079226
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036079226
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License Number State | IL
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