Provider Demographics
NPI:1063417830
Name:SHEFFEY, ROBERT J (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SHEFFEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2205
Mailing Address - Country:US
Mailing Address - Phone:773-239-0702
Mailing Address - Fax:773-239-0712
Practice Address - Street 1:3260 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655
Practice Address - Country:US
Practice Address - Phone:773-239-0702
Practice Address - Fax:773-239-0712
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005133213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636066OtherBCBS
IL016005133Medicaid
ILP00260559OtherRAILROAD MEDICARE
ILP00390803OtherRAILROAD MEDICARE
IL0001621735OtherBCBS
IL131370500OtherDEPT OF LABOR
IL131370500OtherDEPT OF LABOR
ILP00260559OtherRAILROAD MEDICARE
IL0001636066OtherBCBS
ILV04048Medicare UPIN