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General NPI Number Information
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NPI Number | 1720838907
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Entity Type | Individual
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Provider Name | ELIAS MOUSSI SAAD MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 840 S WOOD ST RM. 1424N
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City | CHICAGO
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State | IL
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Zip | 60612-7324
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Country | US
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Telephone | 832-425-9643
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Fax | 253-237-9292
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Provider Business Mailing Address
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Address Line | 840 S WOOD ST # MC856
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City | CHICAGO
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State | IL
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Zip | 60612-7324
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Country | US
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Telephone | 832-425-9643
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Fax | 253-237-9292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125084325
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License Number State | IL
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