Healthcare Provider Details

I. General information

NPI: 1336279025
Provider Name (Legal Business Name): SAHARA PEDIATRICS SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 W DEVON AVE
CHICAGO IL
60659-2128
US

IV. Provider business mailing address

2054 W DEVON AVE
CHICAGO IL
60659-2128
US

V. Phone/Fax

Practice location:
  • Phone: 773-973-2400
  • Fax: 773-973-2480
Mailing address:
  • Phone: 773-973-2400
  • Fax: 773-973-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036074014
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WAHEEDA IQBAL
Title or Position: PRESIDENT
Credential:
Phone: 773-973-2400