MEDICARE: DOMINIKA SAGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1154111417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIKA SAGAN

Provider Business Mailing Address
First Line	:	40 E HURON ST STE 1-200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5244
Country	:	US
Telephone Number	:	312-503-1851
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 E HURON ST STE 1-200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5244
Country	:	US
Telephone Number	:	312-503-1851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/09/2025

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Directions to “ DOMINIKA SAGAN ” Practice Location

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