Provider Demographics
NPI:1255356762
Name:MUNZIR, SYED MOHAMMED (MD)
Entity type:Individual
Prefix:MR
First Name:SYED
Middle Name:MOHAMMED
Last Name:MUNZIR
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 1:40 N AIRLITE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4965
Mailing Address - Country:US
Mailing Address - Phone:847-628-9977
Mailing Address - Fax:847-628-9955
Practice Address - Street 1:40 N AIRLITE ST STE 4
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4965
Practice Address - Country:US
Practice Address - Phone:847-628-9977
Practice Address - Fax:847-628-9955
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1086362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00210692OtherRAILROAD MEDICARE
IL036108636Medicaid
IL0004923104OtherBLUE SHIELD
ILK12567Medicare ID - Type Unspecified
IL036108636Medicaid
IL0004923104OtherBLUE SHIELD