Healthcare Provider Details

I. General information

NPI: 1255727665
Provider Name (Legal Business Name): KATHLEEN SAOUD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 03/23/2023
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

9660 WICKER AVE FL 2
SAINT JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 219-226-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02005392A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.144295
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: