Provider Demographics
NPI:1427000207
Name:WOODHOUSE, SHERMIAN ANTOINETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERMIAN
Middle Name:ANTOINETTE
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:309-451-2231
Mailing Address - Fax:
Practice Address - Street 1:407 E VERNON AVENUE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3813
Practice Address - Country:US
Practice Address - Phone:309-451-2231
Practice Address - Fax:309-451-2299
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361265442085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126544Medicaid
IL036126544Medicaid
IL6314001Medicare PIN