Provider Demographics
NPI:1164497210
Name:RAZA, SYED KAZIM (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:KAZIM
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1775 BALLARD RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1005
Practice Address - Country:US
Practice Address - Phone:847-318-9340
Practice Address - Fax:847-318-2966
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055291207R00000X, 208M00000X
IL036-094429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA489849012EMedicaid
GAP00220529OtherRR MEDICARE-GRP # CC4177
GA489849012BMedicaid
GA10053114OtherAMERIGROUP
GA489849012CMedicaid
GA489849012DMedicaid
GA52703630OtherBCBS
GA8940085OtherUNITED HEALTHCARE
GA340427OtherWELLCARE
GA489849012FMedicaid
GA4609454OtherCIGNA
GA489849012AMedicaid
G33015Medicare UPIN
GA489849012DMedicaid