Healthcare Provider Details

I. General information

NPI: 1427583913
Provider Name (Legal Business Name): SAJJAAD SAMAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR STE 300
DECATUR IL
62526-6322
US

IV. Provider business mailing address

1 MEMORIAL DR STE 300
DECATUR IL
62526-6322
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5500
  • Fax: 217-876-5505
Mailing address:
  • Phone: 217-876-5500
  • Fax: 217-876-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036179284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: