Provider Demographics
NPI:1245748425
Name:EKESA, SEBASTIAN
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:EKESA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 N WINTHROP AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2309
Mailing Address - Country:US
Mailing Address - Phone:773-798-7549
Mailing Address - Fax:
Practice Address - Street 1:5321 N WINTHROP AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2309
Practice Address - Country:US
Practice Address - Phone:773-798-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver