Provider Demographics
NPI:1124118625
Name:RAHIM, SYED ABDUR (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:ABDUR
Last Name:RAHIM
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 1:2150 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2110
Mailing Address - Country:US
Mailing Address - Phone:847-287-4505
Mailing Address - Fax:
Practice Address - Street 1:6501 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3925
Practice Address - Country:US
Practice Address - Phone:847-287-4505
Practice Address - Fax:847-739-7275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50818-202084P0800X, 2084P0804X
IL0361182492084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34966800Medicaid
IL036118249Medicaid
IL036118249Medicaid