Healthcare Provider Details

I. General information

NPI: 1457238834
Provider Name (Legal Business Name): MUKHTAR ALI SYED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 N UNIVERSITY ST
PEORIA IL
61604-1324
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 216
CHICAGO IL
60631-3713
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-9172
  • Fax:
Mailing address:
  • Phone: 773-631-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033386
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number297.011176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: