Provider Demographics
NPI:1538175583
Name:SYED, MUKARAMULLAH (MD)
Entity type:Individual
Prefix:
First Name:MUKARAMULLAH
Middle Name:
Last Name:SYED
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 1:5403 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-479-8166
Mailing Address - Fax:815-880-7806
Practice Address - Street 1:5403 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7410
Practice Address - Country:US
Practice Address - Phone:815-479-8166
Practice Address - Fax:815-880-7806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082303207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5632408OtherBCBS OF IL GROUP #
ILP00918676Medicare PIN
ILIL2207001Medicare PIN
IL5632408OtherBCBS OF IL GROUP #
364025739OtherTAX ID
IL690280OtherBCBS GROUP ID#
ILD93413Medicare UPIN
ILG33521Medicare UPIN
ILP00918676OtherRAILROAD MEDICARE
ILIL2206001Medicare PIN
ILIL2207001Medicare PIN