Healthcare Provider Details

I. General information

NPI: 1952940488
Provider Name (Legal Business Name): SYED HAQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2020
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 E DEMPSTER ST STE 110
DES PLAINES IL
60016-5339
US

IV. Provider business mailing address

2434 E DEMPSTER ST STE 110
DES PLAINES IL
60016-5339
US

V. Phone/Fax

Practice location:
  • Phone: 872-201-8642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number297011174
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number297011174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: