Basic Information
| Provider Information | |||||||||
| NPI: | 1528530771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAJU ABRAHAM, M.D., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7156 W 127TH ST UNIT 300 | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085862080 | ||||||||
| FaxNumber: | 7085752876 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 OGDEN AVE | ||||||||
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| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605045893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309786200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2018 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | ABRAHAM | ||||||||
| AuthorizedOfficialFirstName: | SAJU | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7085862080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 036-124879 | 05 | IL | MEDICAID |