Provider Demographics
NPI:1093325300
Name:SAGAR, FNU
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:SAGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAGAR
Other - Middle Name:
Other - Last Name:KHUBCHANDANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1420 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1941
Mailing Address - Country:US
Mailing Address - Phone:309-308-5195
Mailing Address - Fax:309-308-5095
Practice Address - Street 1:1420 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1941
Practice Address - Country:US
Practice Address - Phone:309-308-5195
Practice Address - Fax:309-308-5095
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.164887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program