MEDICARE: MELISSA SIFUENTES 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	207R00000X	Internal Medicine Physician	86275	WI
2	207R00000X	Internal Medicine Physician	036.148177	IL
3	390200000X	Student in an Organized Health Care Education/Training Program	125.069229	IL

General Provider Information

NPI Number	:	1396194569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SIFUENTES M.D.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W POLK ST STE 912
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-4462
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	02/03/2026

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