Healthcare Provider Details

I. General information

NPI: 1245801265
Provider Name (Legal Business Name): SYED SOHAIB NASIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W STEPHENSON ST
FREEPORT IL
61032-4864
US

IV. Provider business mailing address

421 W EXCHANGE ST
FREEPORT IL
61032-4008
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-6000
  • Fax:
Mailing address:
  • Phone: 815-599-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.172130
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.172130
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: