Healthcare Provider Details

I. General information

NPI: 1841416245
Provider Name (Legal Business Name): MOHAMMAD SAJID HOSAIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S STATE ST
ELGIN IL
60123-7612
US

IV. Provider business mailing address

750 S STATE ST
ELGIN IL
60123
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-1040
  • Fax: 847-429-4920
Mailing address:
  • Phone: 847-742-1040
  • Fax: 847-429-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: