Healthcare Provider Details

I. General information

NPI: 1124188081
Provider Name (Legal Business Name): MOHAMMED MUSADIQ SAEED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 WEST FULLERTON AVENUE
ADDISON IL
60101
US

IV. Provider business mailing address

276 WEST FULLERTON AVENUE
ADDISON IL
60101
US

V. Phone/Fax

Practice location:
  • Phone: 630-543-5454
  • Fax: 630-543-5471
Mailing address:
  • Phone: 630-543-5454
  • Fax: 630-543-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036067984
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2201549
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier036067984
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: