Basic Information
| Provider Information | |||||||||
| NPI: | 1407816044 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 HEALTH CENTER DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619384653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178682812 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 905 N MAPLE ST STE E | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624016401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173477030 | ||||||||
| FaxNumber: | 2173477197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036104430 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 371391171003 | 05 | IL | MEDICAID | 461699 | 01 | IL | HEALTHLINK | OTHER | 0032540072 | 01 | IL | BLUE CROSS BLUE SHIELD IL | OTHER | 170989 | 01 | PERSONAL CARE | OTHER | 076638 | 01 | IL | HEALTH ALLIANCE | OTHER | 080193907 | 01 | IL | RAILROAD MEDICARE | OTHER | 036104430 | 01 | IL | ILLINOIS LICENSE | OTHER | 336065138 | 01 | IL | ILLINOIS CONTROLLED SUBSTANCE LICENSE | OTHER | BF7334737 | 01 | DEA # | OTHER | 1351483 | 01 | FIRST HEALTH/ COVENTRY | OTHER |