Healthcare Provider Details

I. General information

NPI: 1578050878
Provider Name (Legal Business Name): YOUSUF MOHAMMED SYED DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W STEARNS RD
BARTLETT IL
60103-4546
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-0018
US

V. Phone/Fax

Practice location:
  • Phone: 630-213-7788
  • Fax: 630-289-8450
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-157572
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: