Provider Demographics
NPI:1053621037
Name:SOLOMON SIDEA MD PC
Entity type:Organization
Organization Name:SOLOMON SIDEA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-590-1500
Mailing Address - Street 1:1655 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 203E
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3982
Mailing Address - Country:US
Mailing Address - Phone:847-590-1500
Mailing Address - Fax:847-590-1502
Practice Address - Street 1:1655 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 203E
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3982
Practice Address - Country:US
Practice Address - Phone:847-590-1500
Practice Address - Fax:847-590-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083838Medicaid