Healthcare Provider Details

I. General information

NPI: 1992932073
Provider Name (Legal Business Name): EHTESHAMUDDIN SYED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S RANDALL RD
ALGONQUIN IL
60102-5935
US

IV. Provider business mailing address

600 S RANDALL RD FL 1
ALGONQUIN IL
60102-5935
US

V. Phone/Fax

Practice location:
  • Phone: 224-783-4300
  • Fax:
Mailing address:
  • Phone: 224-783-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036129381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: