Provider Demographics
NPI:1003300047
Name:SAYEEDUDDIN, NAELA FATIMA
Entity Type:Individual
Prefix:
First Name:NAELA
Middle Name:FATIMA
Last Name:SAYEEDUDDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 S HARLEM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SUMMIT ARGO
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1407
Mailing Address - Country:US
Mailing Address - Phone:708-215-4000
Mailing Address - Fax:708-416-0089
Practice Address - Street 1:5836 S HARLEM AVE STE 200
Practice Address - Street 2:
Practice Address - City:SUMMIT ARGO
Practice Address - State:IL
Practice Address - Zip Code:60501-1407
Practice Address - Country:US
Practice Address - Phone:708-215-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0317671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.031767Medicaid