Provider Demographics
NPI: | 1871032797 |
---|---|
Name: | SEKHON, DILRAJ SINGH |
Entity type: | Individual |
Prefix: | |
First Name: | DILRAJ |
Middle Name: | SINGH |
Last Name: | SEKHON |
Suffix: | |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 559 N CHESTNUT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ADDISON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60101-2845 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 773-879-2720 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10400 HALIGUS RD |
Practice Address - Street 2: | |
Practice Address - City: | HUNTLEY |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60142-9553 |
Practice Address - Country: | US |
Practice Address - Phone: | 224-654-0000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-02-13 |
Last Update Date: | 2023-08-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 036.159664 | 207RN0300X, 207RC0200X |
OH | 34.014478 | 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
Yes | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2565399 | Medicaid |