Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019.031767 | IL |
Y | 213EG0000X | General Practice | 019.031767 | IL |
NPI | 1003300047 |
---|---|
Provider Name | Naela Fatima Sayeeduddin |
First Address | Summit Argo, IL 60501-1407 |
Second Address | Summit Argo, IL 60501-1407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019.031767 | (05) | IL |