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General NPI Number Information
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NPI Number | 1962840090
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Entity Type | Organization
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Legal Business Name | M. SAJJAD, M.D., S.C.
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 2017 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-2504
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Country | US
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Telephone | 773-847-7878
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Fax | 773-847-7879
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Provider Business Mailing Address
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Address Line | 6337 N KEATING AVE
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City | CHICAGO
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State | IL
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Zip | 60646-4425
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Country | US
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Telephone | 773-588-9957
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMED SAJJAD
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Credential | M.D.
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Telephone | 773-588-9957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-122457
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License Number State | IL
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