Provider Demographics
NPI:1093786014
Name:SECEMSKY, SOLOMON I (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:I
Last Name:SECEMSKY
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 1:1710 N RANDALL RD
Mailing Address - Street 2:STE 340
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9400
Mailing Address - Country:US
Mailing Address - Phone:847-695-3168
Mailing Address - Fax:847-695-4289
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:STE 340
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-695-3168
Practice Address - Fax:847-695-4289
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058717207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8257Medicare PIN
IL667420Medicare ID - Type Unspecified
ILC42951Medicare UPIN