Healthcare Provider Details

I. General information

NPI: 1932635083
Provider Name (Legal Business Name): SSD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12151 REGENCY PKWY STE 12165
HUNTLEY IL
60142-7644
US

IV. Provider business mailing address

12151 REGENCY PKWY STE 12165
HUNTLEY IL
60142-7644
US

V. Phone/Fax

Practice location:
  • Phone: 847-230-9808
  • Fax: 847-984-1915
Mailing address:
  • Phone: 847-230-9808
  • Fax: 847-984-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number336072732
License Number StateIL

VIII. Authorized Official

Name: DR. SHAZIA DAUDI
Title or Position: PRESIDENT
Credential: MD
Phone: 847-230-9808