Provider Demographics
NPI:1972696391
Name:SHEREE L. PEGLOW MD PC
Entity Type:Organization
Organization Name:SHEREE L. PEGLOW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEGLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-234-5938
Mailing Address - Street 1:707 N MICHIGAN ST STE 314
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1070
Mailing Address - Country:US
Mailing Address - Phone:574-234-5938
Mailing Address - Fax:
Practice Address - Street 1:707 N MICHIGAN ST STE 314
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1070
Practice Address - Country:US
Practice Address - Phone:574-234-5938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004043207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
239210Medicare ID - Type Unspecified
E11182Medicare UPIN