Provider Demographics
NPI:1255371498
Name:MOEED, SYED A (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:A
Last Name:MOEED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1842 HEATHER ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2077
Mailing Address - Country:US
Mailing Address - Phone:630-378-5183
Mailing Address - Fax:708-422-6534
Practice Address - Street 1:3228 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2314
Practice Address - Country:US
Practice Address - Phone:708-422-6415
Practice Address - Fax:708-422-6534
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036088811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088811OtherSTATE LICENSE
IL036088811OtherSTATE LICENSE