MEDICARE: DR. SYED N GHANI M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	036111607	IL

General Provider Information

NPI Number	:	1205877396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYED N GHANI M.D

Provider Business Mailing Address
First Line	:	4309 W MEDICAL CENTER DR
Second Line	:	B202
City	:	MCHENRY
State	:	IL
Zip	:	60050-8419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 W MEDICAL CENTER DR
Second Line	:	B202
City	:	MCHENRY
State	:	IL
Zip	:	60050-8419
Country	:	US
Telephone Number	:	815-338-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	02/22/2013

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