Basic Information
| Provider Information | |||||||||
| NPI: | 1689867541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | MOHIUDDIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HOLLISTER DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473676781 | ||||||||
| FaxNumber: | 8473677384 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 HOLLISTER DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473676781 | ||||||||
| FaxNumber: | 8473677384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 036-113652 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 904190 | 01 | IL | GROUP ID LOCALITY 15 | OTHER | 4915289 | 01 | IL | BLUE CROSS / BLUE SHIELD | OTHER |