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NPI Code Detail

MEDICARE: JOHN A. SHARUM PA

MEDICARE: JOHN A. SHARUM PA
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
1363A00000XPhysician Assistant085001331IL
2363AS0400XSurgical Physician Assistant085001331IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19700013180OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710973458
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A. SHARUM PA
Provider Business Mailing Address
First Line : 4201 W MEDICAL CENTER DR
Second Line : EMERGENCY DEPARTMENT
City : MCHENRY
State : IL
Zip : 60050-8409
Country : US
Telephone Number : 815-759-4546
Fax Number :
Provider Business Practice Location Address
First Line : 4201 W MEDICAL CENTER DR
Second Line : EMERGENCY DEPARTMENT
City : MCHENRY
State : IL
Zip : 60050-8409
Country : US
Telephone Number : 815-759-4546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 03/14/2016

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Directions to “ JOHN A. SHARUM PA” Practice Location

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