MEDICARE: DR. SHARON LOUISE HORTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	036086692	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532023	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1538153960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON LOUISE HORTON M.D.

Provider Business Mailing Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 190
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-482-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 190
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-482-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	04/06/2012

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