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General NPI Number Information
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NPI Number | 1093385627
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Entity Type | Individual
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Provider Name | MATIULLAH SEHAT MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 7531 S STONY ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60649-3993
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Country | US
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Telephone | 773-947-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 E 75TH ST
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City | CHICAGO
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State | IL
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Zip | 60649-3603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125079026
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 331935
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License Number State | NY
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