Provider Demographics
NPI:1164268173
Name:SAJID, SAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:
Last Name:SAJID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1486
Mailing Address - Country:US
Mailing Address - Phone:737-334-5388
Mailing Address - Fax:
Practice Address - Street 1:331 FULTON ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1486
Practice Address - Country:US
Practice Address - Phone:737-334-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.083683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics