Provider Demographics
NPI:1215098702
Name:CEASER, SHELDON T (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:T
Last Name:CEASER
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 1:231 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2267
Mailing Address - Country:US
Mailing Address - Phone:773-846-1200
Mailing Address - Fax:
Practice Address - Street 1:231 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2267
Practice Address - Country:US
Practice Address - Phone:773-846-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31602649OtherBLUE CROSS AND BLUE SHIEL
IL110022821OtherRAILROAD MEDICARE
IL110022821OtherRAILROAD MEDICARE
IL781530Medicare ID - Type Unspecified