Provider Demographics
NPI:1306986153
Name:MEYERS, SHELDON J (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:J
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE.
Mailing Address - Street 2:SUITE 1305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603
Mailing Address - Country:US
Mailing Address - Phone:312-922-5191
Mailing Address - Fax:312-922-6798
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-922-5191
Practice Address - Fax:312-922-6798
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036-038337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13452Medicare UPIN