Provider Demographics
NPI:1134163090
Name:SHEAREN, JOHN G (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:SHEAREN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2651 HILLCREST DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-4439
Mailing Address - Country:US
Mailing Address - Phone:715-531-6800
Mailing Address - Fax:715-531-6801
Practice Address - Street 1:1997 SLOAN PL
Practice Address - Street 2:SUITE 17
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2094
Practice Address - Country:US
Practice Address - Phone:715-531-6800
Practice Address - Fax:715-531-6801
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-05-31
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Provider Licenses
StateLicense IDTaxonomies
MN25906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN768302200Medicaid
WI32189500Medicaid
MNA96003Medicare UPIN