Healthcare Provider Details

I. General information

NPI: 1235123589
Provider Name (Legal Business Name): SERGEI SHEVLYAGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N LAKE ST
MUNDELEIN IL
60060-1827
US

IV. Provider business mailing address

550 N LAKE ST
MUNDELEIN IL
60060-1827
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-9777
  • Fax: 847-548-9797
Mailing address:
  • Phone: 847-548-9777
  • Fax: 847-548-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-100102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: