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General NPI Number Information
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NPI Number | 1417403072
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE PRIMARY CARE GROUP SC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 7531 S STONY ISLAND AVE SUITE 164
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City | CHICAGO
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State | IL
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Zip | 60649-3954
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Country | US
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Telephone | 773-947-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 S MICHIGAN AVE APT 2909
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City | CHICAGO
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State | IL
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Zip | 60616-4861
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Country | US
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Telephone | 773-947-2831
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | DR. SYED NAJEEB
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Credential | M.D.
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Telephone | 773-947-2831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036111469
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036111469
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License Number State | IL
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