Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-128967 | IL |
N | 111NI0900X | Internist | 036-128967 | IL |
Y | 207R00000X | Internist | 48270-20 | WI |
Y | 111NI0900X | Internist | 48270-20 | WI |
N | 208000000X | Pediatrician | 036-128967 | IL |
N | 208000000X | Pediatrician | 48270-20 | WI |
N | 2080P0202X | Pediatric Cardiologist | 48270 | WI |
NPI | 1124071865 |
---|---|
Provider Name | Mr. Kamil N. Sayegh |
First Address | Osceola, WI 54020-4370 |
Second Address | Osceola, WI 54020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039906263O | HUMANA (01) | |
34660300 | (05) | WI |
I41020 | (02) |