Provider Demographics
NPI:1194048108
Name:PINHAS SHARON MD, LLC
Entity type:Organization
Organization Name:PINHAS SHARON MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PINHAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-746-5779
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-0245
Mailing Address - Country:US
Mailing Address - Phone:708-746-5779
Mailing Address - Fax:
Practice Address - Street 1:4749 LINCOLN MALL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1180
Practice Address - Country:US
Practice Address - Phone:708-481-4200
Practice Address - Fax:708-746-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067968207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty