Provider Demographics
NPI:1487671327
Name:SULTANIAN, SETA SIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SETA
Middle Name:SIRAN
Last Name:SULTANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W KEATING DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2418
Mailing Address - Country:US
Mailing Address - Phone:847-506-1613
Mailing Address - Fax:
Practice Address - Street 1:2015 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4153
Practice Address - Country:US
Practice Address - Phone:847-228-7600
Practice Address - Fax:847-228-7641
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-049696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01607602OtherBLUE CROSS BLUE SHIELD ID
ILC49151Medicare UPIN
IL773331Medicare ID - Type UnspecifiedMEDICARE ID NUMBER