Basic Information
Provider Information | |||||||||
NPI: | 1710211669 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AKHTAR | ||||||||
FirstName: | SYED | ||||||||
MiddleName: | SUMAIR | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12900 PARK PLAZA DRIVE | ||||||||
Address2: | STE 150, MS 7110 | ||||||||
City: | CERRITOS | ||||||||
State: | CA | ||||||||
PostalCode: | 90703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5629774639 | ||||||||
FaxNumber: | 5627414479 | ||||||||
Practice Location | |||||||||
Address1: | 401 HARDING ST NE # 100 | ||||||||
Address2: |   | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 554132801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6123987000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/24/2009 | ||||||||
LastUpdateDate: | 11/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51915 | CT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 01088671 | IN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | ME126818 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 15806 | NV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 69799 | MN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 4301101853 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 036-137974 | IL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.