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NPI Code Detail

MEDICARE: MR. LEON SHERRELL PHYSICIANS ASSISTANT

MEDICARE: MR. LEON SHERRELL PHYSICIANS ASSISTANT
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
1363AM0700XMedical Physician Assistant085003211IL

General Provider Information

NPI Number : 1649395930
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEON SHERRELL PHYSICIANS ASSISTANT
Provider Business Mailing Address
First Line : 654 E 47TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4224
Country : US
Telephone Number : 773-624-4800
Fax Number :
Provider Business Practice Location Address
First Line : 654 E 47TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4224
Country : US
Telephone Number : 773-624-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 10/06/2011

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