1659385128 NPI number — MRS. SHARON MICHELE JAMES MD

Table of content: MRS. SHARON MICHELE JAMES MD (NPI 1659385128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659385128 NPI number — MRS. SHARON MICHELE JAMES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMES
Provider First Name:
SHARON
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STIRGUS-JAMES
Provider Other First Name:
SHARON
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659385128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4685
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60680-4685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-333-3030
Provider Business Mailing Address Fax Number:
708-333-6060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15620 SOUTH WOOD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60426-4171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-333-3030
Provider Business Practice Location Address Fax Number:
708-333-6060
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  036100768 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036100768 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 364385192 . This is a "TAX ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01630253 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 212568 . This is a "GROUP PIN NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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