Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 036-049100 | IL |
NPI | 1063445633 |
---|---|
Provider Name | Winston Sequeira |
First Address | Wheaton, IL 60189-2037 |
Second Address | Wheaton, IL 60189-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 25/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0222075 | BLUE CROSS GROUP NUMBER (01) | IL |
036049100 | (05) | IL |
1033149844 | GROUP NPI (01) | IL |
363149833 | TAX IDENTIFICATION NUMBER (01) | IL |
3631498336019001 | CDPG HFS PAYEE ID (01) | IL |
C45323 | (02) | IL |