Healthcare Provider Details

I. General information

NPI: 1225020076
Provider Name (Legal Business Name): SEAN MICHAEL RARDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 AURORA AVE
NAPERVILLE IL
60540-6274
US

IV. Provider business mailing address

445 AURORA AVE
NAPERVILLE IL
60540-6274
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-8844
  • Fax: 630-355-8848
Mailing address:
  • Phone: 630-355-8844
  • Fax: 630-355-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-114032
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: