MEDICARE: DR. LINDA C. SHERBAHN MD

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	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1578599056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA C. SHERBAHN MD

Provider Business Mailing Address
First Line	:	718 GLENVIEW AVE
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-2432
Country	:	US
Telephone Number	:	847-480-3744
Fax Number	:	847-480-3851

Provider Business Practice Location Address
First Line	:	718 GLENVIEW AVE
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-2432
Country	:	US
Telephone Number	:	847-480-3744
Fax Number	:	847-480-3851

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	07/08/2007

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