Provider Demographics
NPI:1184887960
Name:SHERMAN GROUP PRACTICE INC
Entity type:Organization
Organization Name:SHERMAN GROUP PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UTECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-783-5196
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60121-1509
Mailing Address - Country:US
Mailing Address - Phone:224-238-4160
Mailing Address - Fax:847-783-0599
Practice Address - Street 1:864 W STEARNS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4508
Practice Address - Country:US
Practice Address - Phone:630-830-8192
Practice Address - Fax:630-830-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL217034Medicare PIN
ILDO3447Medicare PIN