Provider Demographics
NPI:1912175811
Name:ALEXANDER SAGAL, MD, SC
Entity Type:Organization
Organization Name:ALEXANDER SAGAL, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, SC
Authorized Official - Phone:773-989-9118
Mailing Address - Street 1:4947 N WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3607
Mailing Address - Country:US
Mailing Address - Phone:773-989-9118
Mailing Address - Fax:773-989-9180
Practice Address - Street 1:4947 N WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3607
Practice Address - Country:US
Practice Address - Phone:773-989-9118
Practice Address - Fax:773-989-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45622Medicare UPIN
IL687750Medicare PIN