Healthcare Provider Details

I. General information

NPI: 1639610553
Provider Name (Legal Business Name): SETH A. EAPPEN, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ENTERPRISE DR STE 220
OAK BROOK IL
60523
US

IV. Provider business mailing address

600 ENTERPRISE DR STE 220
OAK BROOK IL
60523-4202
US

V. Phone/Fax

Practice location:
  • Phone: 844-632-7736
  • Fax: 888-972-3621
Mailing address:
  • Phone: 844-632-7736
  • Fax: 888-972-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SETH EAPPEN
Title or Position: OWNER
Credential: M.D.
Phone: 844-632-7736