Provider Demographics
NPI:1891893525
Name:CIANCIO, SEBASTIAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:JAMES
Last Name:CIANCIO
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 1:707 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-477-4766
Mailing Address - Fax:217-477-4752
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-477-4766
Practice Address - Fax:217-477-4752
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82330208800000X
IL036-116977208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2008515830AMedicaid
IL292136OtherPERSONAL CARE COVENTRY
IL036116977Medicaid
771911OtherHEALTHLINK
IL036116977Medicaid
IN2008515830AMedicaid