Provider Demographics
NPI:1689867541
Name:AHMED, SYED MOHIUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:MOHIUDDIN
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-367-6781
Mailing Address - Fax:847-367-7384
Practice Address - Street 1:1001 COMMERCE DR STE 700
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8865
Practice Address - Country:US
Practice Address - Phone:331-732-4490
Practice Address - Fax:331-732-4491
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-113652207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4915289OtherBLUE CROSS / BLUE SHIELD
IL904190OtherGROUP ID LOCALITY 15
ILK47684Medicare PIN