Individual
MR. SANJAI NAICHERIL SABU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
675 N SAINT CLAIR ST STE 21-100, CHICAGO, IL 60611-5970
(312) 695-0990
(312) 695-1106
Mailing address
675 N SAINT CLAIR ST STE 21-100, CHICAGO, IL 60611-5970
(312) 695-0990
(312) 695-1106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010457
IL
363A00000X
Physician Assistant
PA13924
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421268001
—
TX
01
—
421268002
MEDICAID - CSHCN
TX
Enumeration date
09/11/2020
Last updated
09/19/2024
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