Provider Demographics
NPI:1013163120
Name:SINHA, SWASTIK KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SWASTIK
Middle Name:KUMAR
Last Name:SINHA
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 1:1191 FORTUNE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7474
Mailing Address - Country:US
Mailing Address - Phone:618-713-5211
Mailing Address - Fax:
Practice Address - Street 1:1191 FORTUNE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7474
Practice Address - Country:US
Practice Address - Phone:618-607-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60275071207X00000X
GA061519207X00000X
MO2021003795207X00000X
IL036143876207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036143876Medicaid