Provider Demographics
NPI:1144955063
Name:MUTTAR, SAAD (MD)
Entity type:Individual
Prefix:
First Name:SAAD
Middle Name:
Last Name:MUTTAR
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 1:10044 BRONX AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1002
Mailing Address - Country:US
Mailing Address - Phone:872-235-8881
Mailing Address - Fax:
Practice Address - Street 1:4001 W DEVON AVE STE 507
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4540
Practice Address - Country:US
Practice Address - Phone:773-853-0857
Practice Address - Fax:872-804-2266
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00000000000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty