Provider Demographics
NPI:1801200456
Name:SYED, YAQOOB M (DO)
Entity Type:Individual
Prefix:DR
First Name:YAQOOB
Middle Name:M
Last Name:SYED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 ROHLWING RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1338
Mailing Address - Country:US
Mailing Address - Phone:847-618-0850
Mailing Address - Fax:847-618-0859
Practice Address - Street 1:1941 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1338
Practice Address - Country:US
Practice Address - Phone:847-618-0850
Practice Address - Fax:847-618-0859
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-064586207Q00000X
IL036141562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801200456Medicaid
IL036141562OtherSTATE LICENSE