Provider Demographics
NPI:1609980754
Name:SYED S. ASGHAR M.D.P.C.
Entity Type:Organization
Organization Name:SYED S. ASGHAR M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASGHAR
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:815-459-3030
Mailing Address - Street 1:80 N VIRGINIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4158
Mailing Address - Country:US
Mailing Address - Phone:815-459-3030
Mailing Address - Fax:815-459-9709
Practice Address - Street 1:80 N VIRGINIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4158
Practice Address - Country:US
Practice Address - Phone:815-459-3030
Practice Address - Fax:815-459-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360762111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
904042Medicare PIN