MEDICARE: MUKARAMULLAH SYED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	036082303	IL
2	207RC0000X	Cardiovascular Disease Physician	036082303	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5632408	OTHER	IL	BCBS OF IL GROUP #

General Provider Information

NPI Number	:	1538175583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKARAMULLAH SYED M.D.

Provider Business Mailing Address
First Line	:	5403 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-479-8166
Fax Number	:	815-880-7806

Provider Business Practice Location Address
First Line	:	5403 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-479-8166
Fax Number	:	815-880-7806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/22/2021

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