Provider Demographics
NPI:1942283825
Name:DAVID, SEAN P (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9977 WOODS DR FL 1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:224-964-2273
Mailing Address - Fax:847-663-8290
Practice Address - Street 1:9977 WOODS DR FL 1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:224-364-2273
Practice Address - Fax:847-663-8290
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-10-12
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Provider Licenses
StateLicense IDTaxonomies
IL036.148964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021063Medicaid
RIH11734Medicare UPIN
RI9021063Medicaid
RI0089021063Medicare PIN