Basic Information
| Provider Information | |||||||||
| NPI: | 1316133648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SICA | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | ALEJANDRO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 S WOOD STREET SUITE 820-E M/C 713 | ||||||||
| Address2: | 713 837 CSB | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129969424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 PAGE STREET | ||||||||
| Address2: | SOUTHCOAST PHYSICIAN SERVICES, INC. | ||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089615919 | ||||||||
| FaxNumber: | 5089615916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 242439 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.