Healthcare Provider Details

I. General information

NPI: 1073259610
Provider Name (Legal Business Name): SEBASTIAN ALEXANDER HOAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

IV. Provider business mailing address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 312-227-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.174597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: