Provider Demographics
NPI:1790006393
Name:KHALID, SYED ZAHID AZIZ (DO)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:ZAHID AZIZ
Last Name:KHALID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ZAHID
Other - Middle Name:AZIZ
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2520 ELISHA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099
Mailing Address - Country:US
Mailing Address - Phone:847-872-6259
Mailing Address - Fax:847-872-5716
Practice Address - Street 1:2361 PAYSPHERE CIRCLE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60674
Practice Address - Country:US
Practice Address - Phone:847-746-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.131684207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
560310134Medicare UPIN