Provider Demographics
NPI:1912177023
Name:IJLALUDDIN, SADIA (MD)
Entity Type:Individual
Prefix:
First Name:SADIA
Middle Name:
Last Name:IJLALUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SADIA
Other - Middle Name:
Other - Last Name:KHALIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 WATERVIEW WAY
Mailing Address - Street 2:APT C
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822
Mailing Address - Country:US
Mailing Address - Phone:217-531-7949
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK STREET
Practice Address - Street 2:LL FORUM BUILDING
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-383-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine