Provider Demographics
NPI:1093813156
Name:OO, SAW M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAW
Middle Name:M
Last Name:OO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LARRY POWER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5195
Mailing Address - Country:US
Mailing Address - Phone:815-523-7020
Mailing Address - Fax:815-523-7022
Practice Address - Street 1:370 LARRY POWER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5195
Practice Address - Country:US
Practice Address - Phone:815-523-7020
Practice Address - Fax:815-523-7022
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36108040Medicaid
IL4632039OtherBC GROUP #
IL4632039OtherBC GROUP #
H97475Medicare UPIN
IL36-3167726Medicare ID - Type UnspecifiedGROUP TAX ID#
ILK04805Medicare PIN
IL356254Medicare ID - Type UnspecifiedMCD GROUP # WILL COUNTY
IL36108040Medicaid