Healthcare Provider Details

I. General information

NPI: 1205568904
Provider Name (Legal Business Name): SAMI SINADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3993
US

IV. Provider business mailing address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3993
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7313
  • Fax:
Mailing address:
  • Phone: 773-947-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.080634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: