Provider Demographics
NPI:1114906005
Name:ABDUL-AZIZ, SYED (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:ABDUL-AZIZ
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 1:180 S 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1952
Mailing Address - Country:US
Mailing Address - Phone:618-213-7933
Mailing Address - Fax:618-213-7364
Practice Address - Street 1:180 S 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1952
Practice Address - Country:US
Practice Address - Phone:618-213-7933
Practice Address - Fax:618-213-7364
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013891174400000X
IL036-108734174400000X
IL036108734207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-108734Medicaid
IL1114906005Medicaid
IL1114906005Medicaid
ILIL3348006Medicare PIN