Provider Demographics
NPI:1093522252
Name:JIWANI, SAHAR
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:JIWANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 N SHERIDAN RD APT 3311
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1984
Mailing Address - Country:US
Mailing Address - Phone:224-261-9091
Mailing Address - Fax:
Practice Address - Street 1:5415 N SHERIDAN RD APT 3311
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1984
Practice Address - Country:US
Practice Address - Phone:224-261-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant