Provider Demographics
NPI:1255339677
Name:SYED, MASOOD S (MD)
Entity type:Individual
Prefix:DR
First Name:MASOOD
Middle Name:S
Last Name:SYED
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 1:704 S NOAH TER
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3558
Mailing Address - Country:US
Mailing Address - Phone:773-776-9822
Mailing Address - Fax:773-776-9865
Practice Address - Street 1:2636 W 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2082
Practice Address - Country:US
Practice Address - Phone:773-776-9822
Practice Address - Fax:773-776-9865
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL544110Medicare ID - Type Unspecified
ILF74213Medicare UPIN