Provider Demographics
NPI:1740926138
Name:UDDIN, SAYAM FAWAD (MD)
Entity type:Individual
Prefix:DR
First Name:SAYAM
Middle Name:FAWAD
Last Name:UDDIN
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 1:11307 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5407
Mailing Address - Country:US
Mailing Address - Phone:352-592-2753
Mailing Address - Fax:
Practice Address - Street 1:530 NE GLEN OAK AVE POB SUITE 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-5407
Practice Address - Country:US
Practice Address - Phone:309-624-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.175776207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine