Provider Demographics
NPI:1043297997
Name:FORSYTHE, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(321 N. LAGRANGE RD, LAGRANGE PARK, IL. 60526)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-485-1020
Mailing Address - Fax:708-485-1173
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(321 N. LAGRANGE RD, LAGRANGE PARK, IL. 60526)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-485-1020
Practice Address - Fax:708-485-1173
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36088626207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36088626Medicaid
ILL80829Medicare ID - Type Unspecified
IL36088626Medicaid
IL588020Medicare ID - Type Unspecified