Healthcare Provider Details

I. General information

NPI: 1720838907
Provider Name (Legal Business Name): ELIAS MOUSSI SAAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 07/03/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST RM. 1424N
CHICAGO IL
60612-7324
US

IV. Provider business mailing address

840 S WOOD ST # MC856
CHICAGO IL
60612-7324
US

V. Phone/Fax

Practice location:
  • Phone: 832-425-9643
  • Fax: 253-237-9292
Mailing address:
  • Phone: 832-425-9643
  • Fax: 253-237-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125084325
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: