Provider Demographics
NPI:1174527550
Name:ABRAHAM, SHERYN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERYN
Middle Name:
Last Name:ABRAHAM
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 1:8600 75TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8200
Mailing Address - Country:US
Mailing Address - Phone:262-652-9430
Mailing Address - Fax:262-652-9433
Practice Address - Street 1:8600 75TH ST
Practice Address - Street 2:STE 101
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8200
Practice Address - Country:US
Practice Address - Phone:262-652-9430
Practice Address - Fax:262-652-9433
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174527550Medicaid