Provider Demographics
NPI:1033167952
Name:SISON, JOSE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:S
Last Name:SISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:185 PENNY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1454
Mailing Address - Country:US
Mailing Address - Phone:847-836-7015
Mailing Address - Fax:847-428-9291
Practice Address - Street 1:2000 OGDEN AVE
Practice Address - Street 2:RUSH COPLEY MEDICAL CENTER
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7222
Practice Address - Country:US
Practice Address - Phone:630-978-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036049681207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18611Medicare UPIN
ILL77127Medicare PIN