MEDICARE: MS. NAVEED HYDERI PA-C

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	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1912994054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NAVEED HYDERI PA-C

Provider Business Mailing Address
First Line	:	3537 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0035
Country	:	US
Telephone Number	:	708-786-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2132
Country	:	US
Telephone Number	:	773-277-6589
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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