Healthcare Provider Details

I. General information

NPI: 1306231931
Provider Name (Legal Business Name): SARAH SEFCOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N MILWAUKEE AVE
CHICAGO IL
60647-5453
US

IV. Provider business mailing address

1776 N MILWAUKEE AVE
CHICAGO IL
60647-5453
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax: 773-862-1454
Mailing address:
  • Phone: 312-926-3627
  • Fax: 773-862-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.144847
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.144847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: