Provider Demographics
NPI:1104046630
Name:WALIUDDIN, SYED (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:WALIUDDIN
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 1:75 MARKET ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5093
Mailing Address - Country:US
Mailing Address - Phone:847-697-6290
Mailing Address - Fax:847-697-0252
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:SUITE 14
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5093
Practice Address - Country:US
Practice Address - Phone:847-697-6290
Practice Address - Fax:847-697-0252
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI502822084P0804X, 2084P0800X
IL0361197262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry