Provider Demographics
NPI:1518346253
Name:SYED, NICOLE Z (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:Z
Last Name:SYED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5759
Mailing Address - Country:US
Mailing Address - Phone:708-763-2328
Mailing Address - Fax:708-345-9984
Practice Address - Street 1:7411 LAKE ST STE 1120
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1882
Practice Address - Country:US
Practice Address - Phone:708-345-3076
Practice Address - Fax:708-345-9984
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA151455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program