MEDICARE: IDA SEBASTIAN MD

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	207VX0000X	Obstetrics Physician	28608	FL

General Provider Information

NPI Number	:	1407803430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA SEBASTIAN MD

Provider Business Mailing Address
First Line	:	4526 SAINT ANDREWS DRIVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4426
Country	:	US
Telephone Number	:	561-737-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 SOUTHWINDS DRIVE
Second Line	:	LANTANA HEALTH DEPARTMENT
City	:	LANTANA
State	:	FL
Zip	:	33462
Country	:	US
Telephone Number	:	561-547-6800
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	03/08/2026

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