Provider Demographics
NPI:1861408510
Name:DORODI, SHERVIN (MD)
Entity type:Individual
Prefix:
First Name:SHERVIN
Middle Name:
Last Name:DORODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E GOLF ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1252
Mailing Address - Country:US
Mailing Address - Phone:847-297-2636
Mailing Address - Fax:847-297-3252
Practice Address - Street 1:1400 E GOLF ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1252
Practice Address - Country:US
Practice Address - Phone:847-297-2636
Practice Address - Fax:847-297-3252
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85638207Q00000X
GA54267207Q00000X
IL036105942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL775321OtherGOLD PLUS HUMANA
IL01634205OtherBCBS OF IL
IL8701968OtherCIGNA
IL036105942Medicaid
IL8701968OtherCIGNA
ILK05368Medicare ID - Type Unspecified