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Individual
ANDREW SAGAN
Active
Individual
ANDREW SAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-097505
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
406120
MEDICARE PTAN FOR SCMG
IL
01
—
F400195183
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
07/13/2006
Last updated
02/11/2016
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