Provider Demographics
NPI:1073666863
Name:RAJA NAVEED SADIQ, MD SC
Entity Type:Organization
Organization Name:RAJA NAVEED SADIQ, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:SADIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-352-2226
Mailing Address - Street 1:501 NORTH DUNLAP
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-8402
Mailing Address - Country:US
Mailing Address - Phone:217-352-2226
Mailing Address - Fax:217-352-2251
Practice Address - Street 1:501 N DUNLAP AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-8403
Practice Address - Country:US
Practice Address - Phone:217-352-2226
Practice Address - Fax:217-352-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-121813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209468Medicare ID - Type UnspecifiedMEDICARE GROUP PROV#