Provider Demographics
NPI:1376299818
Name:PHILIP, SAJAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SAJAN
Middle Name:
Last Name:PHILIP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PORTER LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2082
Mailing Address - Country:US
Mailing Address - Phone:331-645-9662
Mailing Address - Fax:
Practice Address - Street 1:693 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1752
Practice Address - Country:US
Practice Address - Phone:331-645-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical