Healthcare Provider Details

I. General information

NPI: 1114974441
Provider Name (Legal Business Name): VENKAT E SEKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N LOGAN AVE DANVILLE POLYCLINIC, LTD.
DANVILLE IL
61832-4360
US

IV. Provider business mailing address

707 N LOGAN AVE DANVILLE POLYCLINIC, LTD.
DANVILLE IL
61832-4360
US

V. Phone/Fax

Practice location:
  • Phone: 217-477-4772
  • Fax: 217-477-4704
Mailing address:
  • Phone: 217-477-4772
  • Fax: 217-477-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036073793
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036073793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: