Provider Demographics
NPI:1295725323
Name:SHARKEY, CARRIE (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:SHARKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:SHARKEY-ASNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1601 PARKVIEW AVENUE
Mailing Address - Street 2:CREDENTIALING S200C
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2231
Mailing Address - Country:US
Mailing Address - Phone:815-395-5861
Mailing Address - Fax:815-395-5575
Practice Address - Street 1:1221 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2231
Practice Address - Country:US
Practice Address - Phone:815-972-1000
Practice Address - Fax:815-972-1086
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082688OtherIL STATE LICENSE
IL036082688Medicaid
IL336044959OtherIL STATE CTL SUBS LICENSE
IL036082688Medicaid
ILBS4160355OtherDEA
IL036082688OtherIL STATE LICENSE