MEDICARE: LINAS A. SIDRYS 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	207W00000X	Ophthalmology Physician	036-058239	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180009600	OTHER	IL	RAILROAD MEDICARE
5	180046260	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05032013	OTHER	IL	BLUE CROSS
3	207W00000X	OTHER	IL	TAXONOMY CODE
4	036-058239	OTHER	IL	ILLINOIS LCENSE
6	21629784	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1154407880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINAS A. SIDRYS M.D.

Provider Business Mailing Address
First Line	:	5706 111TH ST
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2407
Country	:	US
Telephone Number	:	708-636-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 111TH ST
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2407
Country	:	US
Telephone Number	:	708-636-6622
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	12/22/2021

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