Provider Demographics
NPI:1447305644
Name:SHARI L. BORNSTEIN MD
Entity type:Organization
Organization Name:SHARI L. BORNSTEIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-662-4300
Mailing Address - Street 1:501 N. RIVERSIDE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2701
Mailing Address - Country:US
Mailing Address - Phone:847-662-4300
Mailing Address - Fax:847-662-2008
Practice Address - Street 1:501 N. RIVERSIDE DR
Practice Address - Street 2:#106
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2701
Practice Address - Country:US
Practice Address - Phone:847-662-4300
Practice Address - Fax:847-662-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932064OtherBLUE CROSS
ILE99276Medicare UPIN
IL202120Medicare ID - Type Unspecified