Provider Demographics
NPI:1669604997
Name:COLEMAN R. SESKIND, M.D., S.C.
Entity type:Organization
Organization Name:COLEMAN R. SESKIND, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLEMAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SESKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-726-7595
Mailing Address - Street 1:100 E HURON ST
Mailing Address - Street 2:1704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2932
Mailing Address - Country:US
Mailing Address - Phone:312-726-7595
Mailing Address - Fax:312-726-1054
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:312-726-7595
Practice Address - Fax:312-726-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3637930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1628701OtherBLUECROSS/BLUE SHIELD
IL425790Medicare PIN
ILC40473Medicare UPIN