Provider Demographics
NPI:1104082676
Name:SYED, ISHAQ YOUSUF (MD)
Entity type:Individual
Prefix:DR
First Name:ISHAQ
Middle Name:YOUSUF
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 1:3900 JUNIUS ST STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1743
Mailing Address - Country:US
Mailing Address - Phone:469-800-7200
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1621
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:469-800-7210
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4309207XS0117X
NC2010-00477207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915247Medicaid
NC5915247Medicaid