Provider Demographics
NPI:1881656049
Name:MURTAZA, SAJJAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJJAD
Middle Name:
Last Name:MURTAZA
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 1:820 W JACKSON BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3026
Mailing Address - Country:US
Mailing Address - Phone:312-757-4647
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3026
Practice Address - Country:US
Practice Address - Phone:312-757-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117058208VP0014X
MI4301086836208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301086836OtherBOARD OF MEDICINE LICENSE
IL036117058OtherSTATE LICENSE