Provider Demographics
NPI:1558563817
Name:SYED, ATIQ
Entity Type:Individual
Prefix:
First Name:ATIQ
Middle Name:
Last Name:SYED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 N 91ST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:10615 W THUNDERBIRD BLVD STE C100
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3097
Practice Address - Country:US
Practice Address - Phone:623-974-1763
Practice Address - Fax:623-972-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50254207RN0300X
KY44955207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008545Medicaid