Provider Demographics
NPI:1720099195
Name:GAYED, NASSER MIKHAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:MIKHAIL
Last Name:GAYED
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 1:2401 W ALTA RD
Mailing Address - Street 2:APT 1306
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1279
Mailing Address - Country:US
Mailing Address - Phone:815-822-8516
Mailing Address - Fax:
Practice Address - Street 1:411 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2414
Practice Address - Country:US
Practice Address - Phone:309-497-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine