MEDICARE: PIMENTEL-SYCHAY MEDICAL SERVICE CORPORATION

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	207Q00000X	Family Medicine Physician	036066233	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01626031	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326209818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIMENTEL-SYCHAY MEDICAL SERVICE CORPORATION

Provider Business Mailing Address
First Line	:	6628 SHEFFIELD LN
Second Line	:
City	:	WILLOWBROOK
State	:	IL
Zip	:	60527-5427
Country	:	US
Telephone Number	:	773-651-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6032 S HALSTED ST # 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2112
Country	:	US
Telephone Number	:	773-651-9200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SONIA P SYCHAY
Credential	:	MD
Telephone Number	:	773-651-9200

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	12/04/2019

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Directions to “PIMENTEL-SYCHAY MEDICAL SERVICE CORPORATION ” Practice Location

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