Provider Demographics
NPI:1720838907
Name:MOUSSI SAAD, ELIAS (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:MOUSSI SAAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST # MC856
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7324
Mailing Address - Country:US
Mailing Address - Phone:832-425-9643
Mailing Address - Fax:253-237-9292
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:RM. 1424N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7324
Practice Address - Country:US
Practice Address - Phone:832-425-9643
Practice Address - Fax:253-237-9292
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125084325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics