Provider Demographics
NPI:1578713780
Name:LINAS A. SIDRYS M.D.
Entity Type:Organization
Organization Name:LINAS A. SIDRYS M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDRYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-672-4018
Mailing Address - Street 1:111 WESTGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2767
Mailing Address - Country:US
Mailing Address - Phone:815-672-4018
Mailing Address - Fax:815-672-5160
Practice Address - Street 1:111 WESTGATE PLZ
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2767
Practice Address - Country:US
Practice Address - Phone:815-672-4018
Practice Address - Fax:815-672-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058239Medicaid
IL036058239Medicaid
IL568870Medicare PIN