Provider Demographics
NPI:1790023497
Name:SHARKEY, PHILIP HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:HENRY
Last Name:SHARKEY
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 1:4666 E POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-2549
Mailing Address - Country:US
Mailing Address - Phone:217-423-3792
Mailing Address - Fax:
Practice Address - Street 1:4666 E POWERS BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-2549
Practice Address - Country:US
Practice Address - Phone:217-423-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.037370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37907OtherUPIN