Basic Information
| Provider Information | |||||||||
| NPI: | 1891052239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHERMAN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5121 MARYLAND WAY | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159286275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1324 N SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | WAUKEGAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600852161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473603000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD043310 | DC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | FS6627698 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.