Healthcare Provider Details

I. General information

NPI: 1053393439
Provider Name (Legal Business Name): SYED M AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W HIGH ST LOWER LEVEL
MORRIS IL
60450-1407
US

IV. Provider business mailing address

201 S WABENA AVE SUITE 2B
MINOOKA IL
60447-8715
US

V. Phone/Fax

Practice location:
  • Phone: 815-705-1000
  • Fax: 815-705-2709
Mailing address:
  • Phone: 815-941-9124
  • Fax: 815-941-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34178
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: