Healthcare Provider Details

I. General information

NPI: 1295595890
Provider Name (Legal Business Name): SIOBHAN CHRISTINE WEST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

6549 N NEWGARD AVE
CHICAGO IL
60626-5092
US

V. Phone/Fax

Practice location:
  • Phone: 847-323-6792
  • Fax:
Mailing address:
  • Phone: 847-323-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.085395
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: