Provider Demographics
NPI:1629182712
Name:ASGHAR, SYED S (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:S
Last Name:ASGHAR
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 1:80 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360762111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360762111Medicaid
IL0360762111Medicaid
ILE18977Medicare UPIN