Provider Demographics
NPI:1619950250
Name:SHARON, GREG EDWARD (MD,)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:EDWARD
Last Name:SHARON
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 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:STE # 403
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-894-7083
Mailing Address - Fax:630-894-9472
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:STE # 403
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-894-7083
Practice Address - Fax:630-894-9472
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067184207KA0200X, 207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067184Medicaid
IL5254328OtherAETNA
IL0280127OtherUNITED
IL0300003362OtherRAILROAD MEDICARE
IL363765151OtherFEIN
IL2215630OtherBCBS
IL036067184Medicaid
IL0280127OtherUNITED