Healthcare Provider Details

I. General information

NPI: 1770163313
Provider Name (Legal Business Name): SYED HUSSAINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N HIGHLAND AVE STE 100
AURORA IL
60506-1459
US

IV. Provider business mailing address

1315 N HIGHLAND AVE STE 100
AURORA IL
60506-1459
US

V. Phone/Fax

Practice location:
  • Phone: 630-413-9119
  • Fax: 312-429-4551
Mailing address:
  • Phone: 630-413-9119
  • Fax: 312-429-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036176548
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351049405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: