Healthcare Provider Details

I. General information

NPI: 1154433621
Provider Name (Legal Business Name): JOHN SIFUENTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 NEAL AVE
JOLIET IL
60433-2548
US

IV. Provider business mailing address

18507 BELLAGIO CIR
TINLEY PARK IL
60477-4462
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-8670
  • Fax:
Mailing address:
  • Phone: 815-685-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: