Provider Demographics
NPI:1578552915
Name:LE, SEAN ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ADAM
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:4826 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3604
Practice Address - Country:US
Practice Address - Phone:773-275-8333
Practice Address - Fax:773-275-9297
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036091417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG46343Medicare UPIN