Provider Demographics
NPI:1104050038
Name:SHERMAN PHYSICIAN GROUP, INC
Entity type:Organization
Organization Name:SHERMAN PHYSICIAN GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
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 1:1000 S STATE ST
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-9688
Practice Address - Country:US
Practice Address - Phone:847-683-7543
Practice Address - Fax:847-683-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632414OtherBCBS GROUP
IL05632414OtherBCBS GROUP
ILDP4096Medicare PIN
ILIL2303Medicare PIN
ILIL2305Medicare PIN
ILIL2304Medicare PIN