Provider Demographics
NPI:1437135449
Name:MOISE, SHARON (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MOISE
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 1:660 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1659
Mailing Address - Country:US
Mailing Address - Phone:847-535-5917
Mailing Address - Fax:847-535-5801
Practice Address - Street 1:75 REMITTANCE DR
Practice Address - Street 2:SUITE 1951
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60675-1001
Practice Address - Country:US
Practice Address - Phone:847-535-5917
Practice Address - Fax:847-535-5801
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36107808207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36107808Medicaid