MEDICARE: SAHARA PEDIATRICS SERVICES INC

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	261Q00000X	Clinic/Center
2	208000000X	Pediatrics Physician	036074014	IL

General Provider Information

NPI Number	:	1336279025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHARA PEDIATRICS SERVICES INC

Provider Business Mailing Address
First Line	:	2054 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2128
Country	:	US
Telephone Number	:	773-973-2400
Fax Number	:	773-973-2480

Provider Business Practice Location Address
First Line	:	2054 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2128
Country	:	US
Telephone Number	:	773-973-2400
Fax Number	:	773-973-2480

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAHEEDA IQBAL
Credential	:
Telephone Number	:	773-973-2400

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2024

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