Healthcare Provider Details

I. General information

NPI: 1235542077
Provider Name (Legal Business Name): SAMEENA JAWED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 RYAN PKWY
ALGONQUIN IL
60102-4530
US

IV. Provider business mailing address

1345 RYAN PKWY
ALGONQUIN IL
60102-4530
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-9555
  • Fax:
Mailing address:
  • Phone: 847-658-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125-064893
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036142450
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: