Healthcare Provider Details

I. General information

NPI: 1720251697
Provider Name (Legal Business Name): MAAZ SYED MOHIUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 WEBER RD
CREST HILL IL
60403
US

IV. Provider business mailing address

2228 WEBER RD
CREST HILL IL
60403-0928
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-9900
  • Fax:
Mailing address:
  • Phone: 815-729-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50071
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number336094071
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: