Provider Demographics
NPI:1578665808
Name:SEVIER, CIA-MATTAE SAUNSIDERAE (MD)
Entity Type:Individual
Prefix:DR
First Name:CIA-MATTAE
Middle Name:SAUNSIDERAE
Last Name:SEVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CIA-MATTAE
Other - Middle Name:SAUNSIDERAE
Other - Last Name:SEVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9119 S EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4225
Mailing Address - Country:US
Mailing Address - Phone:773-768-5000
Mailing Address - Fax:773-778-9593
Practice Address - Street 1:3223 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3333
Practice Address - Country:US
Practice Address - Phone:773-768-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-119-418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119418Medicaid
F400110090Medicare Oscar/Certification