Provider Demographics
NPI:1689673964
Name:LAM, SHERIDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIDAN
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 S HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5381
Mailing Address - Country:US
Mailing Address - Phone:630-495-2220
Mailing Address - Fax:630-495-2279
Practice Address - Street 1:2500 S HIGHLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5363
Practice Address - Country:US
Practice Address - Phone:630-495-2220
Practice Address - Fax:630-495-2279
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036071526207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071526Medicaid
ILK27890Medicare PIN
ILE23463Medicare UPIN