Healthcare Provider Details

I. General information

NPI: 1174384085
Provider Name (Legal Business Name): ANNIE SYED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 19638
SPRINGFIELD IL
62794-9638
US

IV. Provider business mailing address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number125.087295
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: