Healthcare Provider Details

I. General information

NPI: 1013081942
Provider Name (Legal Business Name): JONATHAN SEHY M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 STATE ROUTE 162 ANDERSON HOSPITAL, DEPT. OF RADIOLOGY
MARYVILLE IL
62062-8500
US

IV. Provider business mailing address

6800 STATE ROUTE 162 ANDERSON HOSPITAL, DEPT. OF RADIOLOGY
MARYVILLE IL
62062-8500
US

V. Phone/Fax

Practice location:
  • Phone: 314-359-3166
  • Fax:
Mailing address:
  • Phone: 314-359-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2004014818
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.122442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: