Provider Demographics
NPI:1609873249
Name:SHEAFF, CHARLES MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MILTON
Last Name:SHEAFF
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 1:1600 W WALNUT ST
Mailing Address - Street 2:EAST WING 2ND FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1136
Mailing Address - Country:US
Mailing Address - Phone:217-479-5821
Mailing Address - Fax:217-243-7406
Practice Address - Street 1:1600 W WALNUT ST
Practice Address - Street 2:EAST WING 2ND FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1136
Practice Address - Country:US
Practice Address - Phone:217-479-5821
Practice Address - Fax:217-243-7406
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13562Medicare UPIN