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NPI Code Detail

MEDICARE: DR. JOHANN SEBASTIAN JC REYES SERAG MD

MEDICARE: DR. JOHANN SEBASTIAN JC REYES SERAG 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
1207Q00000XFamily Medicine PhysicianMD446474PA
2207Q00000XFamily Medicine Physician036-141804IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112464493OTHERILCAQH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487987814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHANN SEBASTIAN JC REYES SERAG MD
Provider Business Mailing Address
First Line : PO BOX 3603
Second Line :
City : OAK BROOK
State : IL
Zip : 60522-3603
Country : US
Telephone Number : 773-772-7858
Fax Number : 773-276-6668
Provider Business Practice Location Address
First Line : 2720 DIVISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-2853
Country : US
Telephone Number : 773-523-8600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2009
Last Update Date : 09/24/2018

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