Healthcare Provider Details

I. General information

NPI: 1669597910
Provider Name (Legal Business Name): ANTON J. SAHATTCHIEV RSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 W MAPLE AVE
BERKELEY IL
60163-1446
US

IV. Provider business mailing address

5722 W MAPLE AVE
BERKELEY IL
60163-1446
US

V. Phone/Fax

Practice location:
  • Phone: 708-691-9982
  • Fax: 708-544-3807
Mailing address:
  • Phone: 708-691-9982
  • Fax: 708-544-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: