Provider Demographics
NPI:1326209818
Name:PIMENTEL-SYCHAY MEDICAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:PIMENTEL-SYCHAY MEDICAL SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SYCHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-651-9200
Mailing Address - Street 1:6628 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5427
Mailing Address - Country:US
Mailing Address - Phone:773-651-9200
Mailing Address - Fax:
Practice Address - Street 1:6032 S HALSTED ST # 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2112
Practice Address - Country:US
Practice Address - Phone:773-651-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626031OtherBLUE CROSS BLUE SHIELD
IL036066233Medicaid
IL01626031OtherBLUE CROSS BLUE SHIELD