Provider Demographics
NPI:1538132485
Name:SYED, IKRAM B (MD)
Entity Type:Individual
Prefix:
First Name:IKRAM
Middle Name:B
Last Name:SYED
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 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-892-5544
Mailing Address - Fax:440-892-5563
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 130
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-892-5544
Practice Address - Fax:440-892-5563
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0537824Medicaid
OH000000131739OtherANTHEM
OH110137781OtherRAILROAD MEDICARE
OH000000131739OtherANTHEM
OH110137781OtherRAILROAD MEDICARE