Provider Demographics
NPI:1821362393
Name:S T CEASAR MD SC
Entity Type:Organization
Organization Name:S T CEASAR MD SC
Other - Org Name:SHELDON T CEASER, MD SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CEASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-846-1200
Mailing Address - Street 1:231 E. 75TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2267
Mailing Address - Country:US
Mailing Address - Phone:773-846-1200
Mailing Address - Fax:
Practice Address - Street 1:231 E. 75TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2267
Practice Address - Country:US
Practice Address - Phone:773-846-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110022821OtherRAILROAD MEDICARE
IL31602649OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
ILC47876Medicare UPIN
IL781530Medicare PIN