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1720072960

NPI Code Detail

MEDICARE: SYED M HAQUE M.D.

MEDICARE: SYED M HAQUE 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	208M00000X	Hospitalist Physician	31146	IA
2	207R00000X	Internal Medicine Physician	036-095139	IL
3	207R00000X	Internal Medicine Physician	31146	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	421060724	OTHER		TRICARE
2	336056024	OTHER	IL	CONTROLLED SUBSTANCE#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	54808	OTHER	IA	IOWA BC/BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	421060724	OTHER	IA	BILLING TAX ID # FOR CHC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	42106072461	OTHER	IA	JOHN DEERE HEALTH
9	8122859	OTHER	IL	ILLINOIS BC/BS
10	072992	OTHER	IA	HEALTH ALLIANCE #
11	1237527	OTHER	IA	CONTROLLED SUBSTANCE #
12	IA0161	OTHER	IA	JOHN DEERE EDI#

General Provider Information

NPI Number	:	1720072960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED M HAQUE M.D.

Provider Business Mailing Address
First Line	:	2701 17TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5351
Country	:	US
Telephone Number	:	309-779-3200
Fax Number	:	309-779-2755

Provider Business Practice Location Address
First Line	:	2701 17TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5351
Country	:	US
Telephone Number	:	309-779-3200
Fax Number	:	309-779-2755

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	02/09/2024

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Directions to “ SYED M HAQUE M.D.” Practice Location

Language	Start Address	Practice Location

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