Individual
DR. SEAN P TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11560 S KEDZIE AVE STE 100, MERRIONETTE PARK, IL 60803-4517
(708) 824-1114
(708) 824-9341
Mailing address
13011 S 104TH AVE STE 100, PALOS PARK, IL 60464-1508
(708) 478-3600
(708) 478-3552
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036096266
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
036096266
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621208
BLUE CROSS BLUE SHIELD
IL
05
—
036096266
—
IL
01
—
1508810086
HEART CARE CENTERS OF ILLINOIS GROUP NPI
IL
01
—
236550
MEDICARE GROUP
IL
01
—
236551
MEDICARE GROUP
IL
01
—
416810
MEDICARE GROUP
IL
01
—
CD8033
RAILROAD MEDICARE GROUP PTAN NUMBER
IL
01
—
CN2703
RAILROAD MEDICARE GROUP PTAN NUMBER
IL
01
—
P00110155
RAILROAD MEDICARE COOK
IL
01
—
P00227172
RAILROAD MEDICARE WILL
IL
Enumeration date
04/14/2006
Last updated
12/15/2021
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