Healthcare Provider Details

I. General information

NPI: 1275987737
Provider Name (Legal Business Name): SEAN TOKITA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 N MERIDIAN ST
CARMEL IN
46032-1456
US

IV. Provider business mailing address

50 E BELLEVUE PL APT 2402
CHICAGO IL
60611-1170
US

V. Phone/Fax

Practice location:
  • Phone: 626-354-3195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036151238
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02005866A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: