Provider Demographics
NPI:1386683951
Name:GERSHON, SHELDON M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:M
Last Name:GERSHON
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 1:6343 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1403
Mailing Address - Country:US
Mailing Address - Phone:773-764-6522
Mailing Address - Fax:
Practice Address - Street 1:6343 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1403
Practice Address - Country:US
Practice Address - Phone:773-764-6522
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007999207L00000X
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
357801OtherGROUP NUMBER
G96561Medicare UPIN
357801OtherGROUP NUMBER
50073347Medicare ID - Type UnspecifiedRAILROAD RETIREMENT #