Provider Demographics
NPI:1568455467
Name:SHEARON, ELISABETH CLEARY (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CLEARY
Last Name:SHEARON
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 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:2434 INTERSTATE PLAZA DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2671
Practice Address - Country:US
Practice Address - Phone:219-989-3700
Practice Address - Fax:219-845-4088
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106782207ZP0102X
IN01057583A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000647656OtherBC/BS
IN351173213OtherISPAT/INLAND
IN5496757OtherCCN
IN351173213OtherHFN
IL01630255OtherBC/BC
IN8126697OtherCIGNA
INP00816101OtherRAILROAD MEDICARE
IN200440730Medicaid
IN297664OtherBC/BS
IN351173213OtherSAGAMORE
IN200440730Medicaid
IN8126697OtherCIGNA
ILL99727Medicare PIN
IL01630255OtherBC/BC
IN482210DDMedicare PIN