Healthcare Provider Details

I. General information

NPI: 1881656049
Provider Name (Legal Business Name): SAJJAD MURTAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W JACKSON BLVD SUITE 310
CHICAGO IL
60607-3026
US

IV. Provider business mailing address

820 W JACKSON BLVD SUITE 310
CHICAGO IL
60607-3026
US

V. Phone/Fax

Practice location:
  • Phone: 312-757-4647
  • Fax:
Mailing address:
  • Phone: 312-757-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036-117058
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301086836
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: