Healthcare Provider Details

I. General information

NPI: 1104046630
Provider Name (Legal Business Name): SYED WALIUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MARKET ST SUITE 14
ELGIN IL
60123-5093
US

IV. Provider business mailing address

75 MARKET ST SUITE 14
ELGIN IL
60123-5093
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-6290
  • Fax: 847-697-0252
Mailing address:
  • Phone: 847-697-6290
  • Fax: 847-697-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number50282
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50282
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036119726
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01097770A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: