Provider Demographics
NPI:1457315624
Name:TIERNEY, SEAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:TIERNEY
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 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:11560 S KEDZIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-4517
Practice Address - Country:US
Practice Address - Phone:708-824-1114
Practice Address - Fax:708-824-9341
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096266207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUE CROSS BLUE SHIELD
IL416810OtherMEDICARE GROUP
ILP00110155OtherRAILROAD MEDICARE COOK
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL1508810086OtherHEART CARE CENTERS OF ILLINOIS GROUP NPI
IL236550OtherMEDICARE GROUP
IL236551OtherMEDICARE GROUP
ILP00227172OtherRAILROAD MEDICARE WILL
IL036096266Medicaid
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILK07177Medicare ID - Type Unspecified
IL01621208OtherBLUE CROSS BLUE SHIELD
H81082Medicare UPIN