Healthcare Provider Details

I. General information

NPI: 1265529630
Provider Name (Legal Business Name): RAJ M SAJID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W MAIN ST SUITE 3
COLLINSVILLE IL
62234-3043
US

IV. Provider business mailing address

415 W MAIN ST SUITE 3
COLLINSVILLE IL
62234-3043
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-0071
  • Fax: 618-344-7793
Mailing address:
  • Phone: 618-344-0071
  • Fax: 618-344-7793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-115808
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2008026704
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008026704
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-115808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: