Healthcare Provider Details

I. General information

NPI: 1689867541
Provider Name (Legal Business Name): SYED MOHIUDDIN AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COMMERCE DR STE 700
OAK BROOK IL
60523-8865
US

IV. Provider business mailing address

1800 HOLLISTER DR SUITE 112
LIBERTYVILLE IL
60048-5263
US

V. Phone/Fax

Practice location:
  • Phone: 331-732-4490
  • Fax: 331-732-4491
Mailing address:
  • Phone: 847-367-6781
  • Fax: 847-367-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036-113652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: