Provider Demographics
NPI:1063445633
Name:SEQUEIRA, WINSTON (MD)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:SEQUEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BLANCHARD CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2037
Mailing Address - Country:US
Mailing Address - Phone:630-653-4526
Mailing Address - Fax:
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2037
Practice Address - Country:US
Practice Address - Phone:630-653-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-049100207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1033149844OtherGROUP NPI
IL0222075OtherBLUE CROSS GROUP NUMBER
IL363149833OtherTAX IDENTIFICATION NUMBER
IL036049100Medicaid
IL3631498336019001OtherCDPG HFS PAYEE ID
IL3631498336019001OtherCDPG HFS PAYEE ID
IL036049100Medicaid
IL363149833OtherTAX IDENTIFICATION NUMBER
IL0222075OtherBLUE CROSS GROUP NUMBER
ILC45323Medicare UPIN