Provider Demographics
NPI:1295787422
Name:AKHTER, SYED R (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:R
Last Name:AKHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3017 N ASHLAND AVE APT 1N
Mailing Address - Street 2:R & W MEDICAL CTR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3143
Mailing Address - Country:US
Mailing Address - Phone:773-935-1199
Mailing Address - Fax:773-935-1219
Practice Address - Street 1:3017 N ASHLAND AVE APT 1NRW
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3142
Practice Address - Country:US
Practice Address - Phone:773-935-1199
Practice Address - Fax:773-935-1219
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL34327200Medicaid
IL080193555OtherRAILROAD MEDICARE
IL34327200OtherMMAI AND ICP
IL01636488OtherBCBS