Provider Demographics
NPI:1669597910
Name:SAHATTCHIEV, ANTON J (RSA)
Entity type:Individual
Prefix:MR
First Name:ANTON
Middle Name:J
Last Name:SAHATTCHIEV
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
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Mailing Address - Street 1:5722 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1446
Mailing Address - Country:US
Mailing Address - Phone:708-691-9982
Mailing Address - Fax:708-544-3807
Practice Address - Street 1:5722 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:IL
Practice Address - Zip Code:60163-1446
Practice Address - Country:US
Practice Address - Phone:708-691-9982
Practice Address - Fax:708-544-3807
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical