Provider Demographics
NPI:1508900168
Name:THASEEN, SABIHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SABIHA
Middle Name:
Last Name:THASEEN
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 1:5535 W CERMAK RD STE A
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2218
Mailing Address - Country:US
Mailing Address - Phone:708-780-7705
Mailing Address - Fax:708-780-7795
Practice Address - Street 1:5535 W CERMAK RD STE A
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2218
Practice Address - Country:US
Practice Address - Phone:708-780-7705
Practice Address - Fax:708-780-7795
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622612OtherBLUE CROSS BLUE SHIELD
IL036092253Medicaid
IL01622612OtherBLUE CROSS BLUE SHIELD