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NPI Code Detail

MEDICARE: NICOLE Z SYED M.D

MEDICARE: NICOLE Z SYED 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianA151455CA

General Provider Information

NPI Number : 1518346253
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE Z SYED M.D
Provider Business Mailing Address
First Line : 4646 N MARINE DR
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5759
Country : US
Telephone Number : 708-763-2328
Fax Number : 708-345-9984
Provider Business Practice Location Address
First Line : 7411 LAKE ST STE 1120
Second Line :
City : RIVER FOREST
State : IL
Zip : 60305-1882
Country : US
Telephone Number : 708-345-3076
Fax Number : 708-345-9984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2015
Last Update Date : 11/09/2020

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