Provider Demographics
NPI:1811196553
Name:TESFAY, SAMUEL Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:Y
Last Name:TESFAY
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 1:850 N STATE ST
Mailing Address - Street 2:17G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8665
Mailing Address - Country:US
Mailing Address - Phone:312-335-1609
Mailing Address - Fax:
Practice Address - Street 1:850 N STATE ST
Practice Address - Street 2:17G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8665
Practice Address - Country:US
Practice Address - Phone:312-335-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111625207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology