Basic Information
Provider Information
NPI: 1669421244
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LALL
FirstName: SHEERA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 34 CROYDON LN
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605232325
CountryCode: US
TelephoneNumber: 6306845803
FaxNumber: 6303681545
Practice Location
Address1: 1100 E NORRIS DR
Address2:  
City: OTTAWA
State: IL
PostalCode: 613501604
CountryCode: US
TelephoneNumber: 8154333100
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/09/2006
LastUpdateDate: 04/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X36088694ILY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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