Provider Demographics
NPI:1134243942
Name:SHELDON S. GREENBERG, M.D., S.C.
Entity type:Organization
Organization Name:SHELDON S. GREENBERG, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-3365
Mailing Address - Street 1:2835 NORTH SHEFFIELD AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5083
Mailing Address - Country:US
Mailing Address - Phone:773-561-3365
Mailing Address - Fax:773-880-2409
Practice Address - Street 1:2835 NORTH SHEFFIELD AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5083
Practice Address - Country:US
Practice Address - Phone:773-561-3365
Practice Address - Fax:773-880-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360427262084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042726Medicaid
ILD12951Medicare UPIN
IL485630Medicare ID - Type Unspecified