Healthcare Provider Details

I. General information

NPI: 1033898705
Provider Name (Legal Business Name): SAIRA SAJID CHATHA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8187 NORTHWAY DR
HANOVER PARK IL
60133-2432
US

IV. Provider business mailing address

8187 NORTHWAY DR
HANOVER PARK IL
60133-2432
US

V. Phone/Fax

Practice location:
  • Phone: 630-398-1199
  • Fax:
Mailing address:
  • Phone: 630-398-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: