Provider Demographics
NPI:1700999364
Name:FOREMAN, SYD (DO)
Entity Type:Individual
Prefix:DR
First Name:SYD
Middle Name:
Last Name:FOREMAN
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:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-2475
Mailing Address - Country:US
Mailing Address - Phone:773-537-0020
Mailing Address - Fax:773-537-0030
Practice Address - Street 1:900 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3141
Practice Address - Country:US
Practice Address - Phone:773-537-0020
Practice Address - Fax:773-537-0030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360593772080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618742OtherBLUE CROSS ID#
IL036059377Medicaid
IL036059377Medicaid