Provider Demographics
NPI:1043512148
Name:SHARON DUVAL MD SC
Entity Type:Organization
Organization Name:SHARON DUVAL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-214-5100
Mailing Address - Street 1:1710 N RANDALL RD
Mailing Address - Street 2:SUTIE 360
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9400
Mailing Address - Country:US
Mailing Address - Phone:847-214-5100
Mailing Address - Fax:847-214-2964
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUTIE 360
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-214-5100
Practice Address - Fax:847-214-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096320Medicaid
ILIL4915Medicare PIN
ILIL4914Medicare PIN