Provider Demographics
NPI:1619998119
Name:HUSAIN, SYED (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:HUSAIN
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 1:345 W FULLERTON PKWY
Mailing Address - Street 2:SUITE 2903
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2856
Mailing Address - Country:US
Mailing Address - Phone:773-209-6808
Mailing Address - Fax:
Practice Address - Street 1:1251 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1737
Practice Address - Country:US
Practice Address - Phone:312-988-7300
Practice Address - Fax:312-988-7303
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105041207P00000X
IL036105041207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105041Medicaid
ILI43658Medicare UPIN
ILK21764Medicare PIN