Provider Demographics
NPI:1598091472
Name:FITSEM INC
Entity Type:Organization
Organization Name:FITSEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TSEGHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-755-8695
Mailing Address - Street 1:PO BOX 6960
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-6960
Mailing Address - Country:US
Mailing Address - Phone:847-755-8695
Mailing Address - Fax:
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:STE 425
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-755-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361139842080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113984Medicaid