Provider Demographics
NPI:1033226790
Name:SHERBAHN, RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:SHERBAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TOWER COURT
Mailing Address - Street 2:SUITE F
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-662-1818
Mailing Address - Fax:847-662-3001
Practice Address - Street 1:30 TOWER COURT
Practice Address - Street 2:SUITE F
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-662-1818
Practice Address - Fax:847-662-3001
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03608G403207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4908143OtherBCBS
4908143OtherBCBS