MEDICARE: SOUTHSIDE PRIMARY CARE GROUP SC

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	207Q00000X	Family Medicine Physician	036111469	IL
2	207R00000X	Internal Medicine Physician	036111469	IL

General Provider Information

NPI Number	:	1417403072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE PRIMARY CARE GROUP SC

Provider Business Mailing Address
First Line	:	1720 S MICHIGAN AVE APT 2909
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4861
Country	:	US
Telephone Number	:	773-947-2831
Fax Number	:

Provider Business Practice Location Address
First Line	:	7531 S STONY ISLAND AVE
Second Line	:	SUITE 164
City	:	CHICAGO
State	:	IL
Zip	:	60649-3954
Country	:	US
Telephone Number	:	773-947-2831
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	DR. SYED NAJEEB
Credential	:	M.D.
Telephone Number	:	773-947-2831

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	04/07/2026

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