MEDICARE: DR. SEBOUH A GUEYIKIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	036-103347	IL
2	2085R0204X	Vascular & Interventional Radiology Physician	036-103347	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316947062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEBOUH A GUEYIKIAN M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE.
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-2475
Fax Number	:	847-570-2942

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE.
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-2475
Fax Number	:	847-570-2942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	06/14/2022

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Directions to “ DR. SEBOUH A GUEYIKIAN M.D.” Practice Location

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