Individual
DR. JOHANN SEBASTIAN JC REYES SERAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2720 DIVISON ST, CHICAGO, IL 60622-2853
(773) 523-8600
Mailing address
PO BOX 3603, OAK BROOK, IL 60522-3603
(773) 772-7858
(773) 276-6668
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-141804
IL
207Q00000X
Family Medicine Physician
MD446474
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036141804
—
IL
01
—
12464493
CAQH
IL
Enumeration date
09/17/2009
Last updated
09/24/2018
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