Provider Demographics
NPI:1700238813
Name:MAHMOOD, SAJID (MD)
Entity Type:Individual
Prefix:
First Name:SAJID
Middle Name:
Last Name:MAHMOOD
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 1:3505A GREEN BAY RD
Mailing Address - Street 2:APT 304A
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:312-385-9432
Mailing Address - Fax:
Practice Address - Street 1:3505 GREEN BAY RD
Practice Address - Street 2:304A
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3607
Practice Address - Country:US
Practice Address - Phone:312-385-9432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.069383207R00000X
IL036148947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine