Individual
MUTHANA SARTAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2110 FOX DR, CHAMPAIGN, IL 61820-7553
(217) 366-1237
(217) 366-6106
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
(217) 366-6106
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036.132057
IL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
036.132057
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1633878
BCBS PPO
IL
Enumeration date
07/19/2013
Last updated
10/14/2014
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