Provider Demographics
NPI:1790004380
Name:JOSEPH, SEBASTIAN (MD)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:JOSEPH
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:PO BOX 3855
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60132-3855
Mailing Address - Country:US
Mailing Address - Phone:773-785-8000
Mailing Address - Fax:312-533-2818
Practice Address - Street 1:10830 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3126
Practice Address - Country:US
Practice Address - Phone:773-785-8000
Practice Address - Fax:312-533-2818
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.086678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine