Provider Demographics
NPI:1467444950
Name:MEHMOOD, SAJID (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJID
Middle Name:
Last Name:MEHMOOD
Suffix:
Gender:M
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:P.O. BOX 458
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-0458
Mailing Address - Country:US
Mailing Address - Phone:269-687-1136
Mailing Address - Fax:269-684-0189
Practice Address - Street 1:6800 STATE ROUTE 162
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8521
Practice Address - Country:US
Practice Address - Phone:618-288-5711
Practice Address - Fax:618-288-4088
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107055207RC0200X
MI4301095807207RC0200X
MO2005000579207RC0200X
WI46429-020207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207281304Medicaid
ILK13323Medicare ID - Type Unspecified
MO929193481Medicare ID - Type Unspecified
MO207281304Medicaid