Provider Demographics
NPI:1386626935
Name:SAEED, MOAZZAM (MD)
Entity Type:Individual
Prefix:
First Name:MOAZZAM
Middle Name:
Last Name:SAEED
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 1:300 READ ST STE D
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3265
Mailing Address - Country:US
Mailing Address - Phone:815-838-7337
Mailing Address - Fax:815-838-5007
Practice Address - Street 1:300 READ ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3265
Practice Address - Country:US
Practice Address - Phone:815-838-7337
Practice Address - Fax:815-838-5007
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-093806Medicaid