Healthcare Provider Details

I. General information

NPI: 1316927759
Provider Name (Legal Business Name): SANA A ATTAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 W PARK AVE
LIBERTYVILLE IL
60048-2550
US

IV. Provider business mailing address

1027 W. PARK AVE.
LIBERTYVILLE IL
60048
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-2615
  • Fax: 847-367-1801
Mailing address:
  • Phone: 847-367-2615
  • Fax: 847-367-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number036048638
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036048638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: