Provider Demographics
NPI:1962840090
Name:M. SAJJAD, M.D., S.C.
Entity type:Organization
Organization Name:M. SAJJAD, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-588-9957
Mailing Address - Street 1:6337 N KEATING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4425
Mailing Address - Country:US
Mailing Address - Phone:773-588-9957
Mailing Address - Fax:
Practice Address - Street 1:2017 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2504
Practice Address - Country:US
Practice Address - Phone:773-847-7878
Practice Address - Fax:773-847-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-122457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty