1669604997 NPI number — COLEMAN R. SESKIND, M.D., S.C.

Table of content: (NPI 1669604997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669604997 NPI number — COLEMAN R. SESKIND, M.D., S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLEMAN R. SESKIND, M.D., S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669604997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E HURON ST
Provider Second Line Business Mailing Address:
1704
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-726-7595
Provider Business Mailing Address Fax Number:
312-726-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N MICHIGAN AVE
Provider Second Line Business Practice Location Address:
701
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60601-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-726-7595
Provider Business Practice Location Address Fax Number:
312-726-1054
Provider Enumeration Date:
08/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SESKIND
Authorized Official First Name:
COLEMAN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
312-726-7595

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  3637930 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1628701 . This is a "BLUECROSS/BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com