MEDICARE: MR. ANTON J. SAHATTCHIEV RSA

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	363AS0400X	Surgical Physician Assistant		IL

General Provider Information

NPI Number	:	1669597910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTON J. SAHATTCHIEV RSA

Provider Business Mailing Address
First Line	:	5722 W MAPLE AVE
Second Line	:
City	:	BERKELEY
State	:	IL
Zip	:	60163-1446
Country	:	US
Telephone Number	:	708-691-9982
Fax Number	:	708-544-3807

Provider Business Practice Location Address
First Line	:	5722 W MAPLE AVE
Second Line	:
City	:	BERKELEY
State	:	IL
Zip	:	60163-1446
Country	:	US
Telephone Number	:	708-691-9982
Fax Number	:	708-544-3807

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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