Provider Demographics
NPI:1184717506
Name:PEGLOW, SHEREE L (MD)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:L
Last Name:PEGLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032829207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
239210Medicare ID - Type Unspecified
E11182Medicare UPIN