Doctor Name: | JOEL ROBERT SHEPPERD |
NPI Number: | 1689755795 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 01043409A |
Business Practice Address: | 400 E 22nd St Suite F Lombard, IL - 601486104 |
Business Phone Number: | 6307929311 |
Business Fax Number: | 6307929316 |
Mailing Address: | 400 E 22nd St, Suite F LOMBARD |
State: | IL |
Postal Code: | 601486104 |
Phone Number: | 6307929311 |
Fax Number: | 6307929316 |
NPI Enumeration Date: | 10/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01043409A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |