Provider Demographics
NPI:1801864053
Name:SEBASTIAN, SIBY (MD)
Entity Type:Individual
Prefix:
First Name:SIBY
Middle Name:
Last Name:SEBASTIAN
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 1:17002 ASH HILL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6101
Mailing Address - Country:US
Mailing Address - Phone:270-348-1080
Mailing Address - Fax:
Practice Address - Street 1:17002 ASH HILL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6101
Practice Address - Country:US
Practice Address - Phone:270-348-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-12
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38777207P00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6407716700Medicaid
KYI02656Medicare UPIN