Provider Demographics
NPI:1144204504
Name:SWEENEY, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:SWEENEY
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 1:19110 DARVIN DR
Mailing Address - Street 2:STE C
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8595
Mailing Address - Country:US
Mailing Address - Phone:708-390-2290
Mailing Address - Fax:708-390-2299
Practice Address - Street 1:19110 DARVIN DR
Practice Address - Street 2:STE C
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8595
Practice Address - Country:US
Practice Address - Phone:708-390-2290
Practice Address - Fax:708-390-2299
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 085125207XS0117X
IN01042908A207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000220974OtherANTHEM
IL036085125Medicaid
IL01632167OtherBCBS
IN20004327 CK7919OtherRR MEDICARE
ILP00217417-CK5647OtherRR MEDICARE
IN200167380Medicaid
ILDO9194OtherRR MEDICARE
IN4683040001Medicare NSC
IN162520KKKMedicare PIN
IL01632167OtherBCBS
IN20004327 CK7919OtherRR MEDICARE
IL036085125Medicaid
ILIL1703001Medicare PIN