Provider Demographics
NPI:1053393439
Name:AHMED, SYED M (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 S WABENA AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8715
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:151 W HIGH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1407
Practice Address - Country:US
Practice Address - Phone:815-705-1000
Practice Address - Fax:815-705-2709
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2017-05-02
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Provider Licenses
StateLicense IDTaxonomies
IA34178207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036133146Medicaid
IA0241182Medicaid
IAI4058Medicare ID - Type Unspecified
IA0241182Medicaid