Healthcare Provider Details

I. General information

NPI: 1760683619
Provider Name (Legal Business Name): FAKIH S SEALS APN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

6851 S MERRILL AVE
CHICAGO IL
60649-1610
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6700
  • Fax:
Mailing address:
  • Phone: 773-684-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209006333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: