MEDICARE: CHHABLANI AND SHERIDAN, S.C.

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	174400000X	Specialist	0360 29419

General Provider Information

NPI Number	:	1780866186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHHABLANI AND SHERIDAN, S.C.

Provider Business Mailing Address
First Line	:	2800 S ELLIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2907
Country	:	US
Telephone Number	:	630-920-1601
Fax Number	:	630-455-1806

Provider Business Practice Location Address
First Line	:	2800 S ELLIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2907
Country	:	US
Telephone Number	:	630-920-1601
Fax Number	:	630-455-1806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH T. SHERIDAN
Credential	:	M.D.
Telephone Number	:	630-920-1601

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	05/02/2008

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