Healthcare Provider Details

I. General information

NPI: 1316254873
Provider Name (Legal Business Name): SEBY S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2010
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 S HALSTED ST
CHICAGO IL
60628-3126
US

IV. Provider business mailing address

P O POX 3855
CAROL STREAM IL
60132-3855
US

V. Phone/Fax

Practice location:
  • Phone: 773-785-8000
  • Fax: 312-533-2818
Mailing address:
  • Phone: 773-785-8000
  • Fax: 312-533-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEBASTIAN JOSEPH
Title or Position: PRESIDENT
Credential: MD
Phone: 773-785-8000