MEDICARE: DR. SEEMA SAHAI SHETH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	036127274	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO1231093	OTHER	IL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1053519595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEEMA SAHAI SHETH M.D.

Provider Business Mailing Address
First Line	:	8691 CREST CT
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-7126
Country	:	US
Telephone Number	:	515-835-7535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1530
Country	:	US
Telephone Number	:	847-394-1320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	04/06/2015

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