Provider Demographics
NPI:1629050307
Name:MCCAIN, SEAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:E
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6394
Mailing Address - Country:US
Mailing Address - Phone:618-997-2161
Mailing Address - Fax:618-997-2420
Practice Address - Street 1:3411 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6394
Practice Address - Country:US
Practice Address - Phone:618-997-2161
Practice Address - Fax:618-997-2420
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00401574OtherRR MEDICARE
P00401574OtherRR MEDICARE
ILK24981Medicare PIN