Provider Demographics
NPI:1275569584
Name:URSO, SHERRI LYNN KLIS (MD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN KLIS
Last Name:URSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:799 ROOSEVELT RD STE 4-314
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5909
Mailing Address - Country:US
Mailing Address - Phone:630-886-7376
Mailing Address - Fax:630-545-1577
Practice Address - Street 1:799 ROOSEVELT RD STE 4-314
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5909
Practice Address - Country:US
Practice Address - Phone:630-886-7376
Practice Address - Fax:630-545-1577
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361043052084P0800X
IL036-1043052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209697Medicare ID - Type Unspecified
ILH71537Medicare UPIN