Provider Demographics
NPI:1154377836
Name:KHADRI, SYED YOUSUF (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:YOUSUF
Last Name:KHADRI
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 1:621 PLAINFIELD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WILLOW BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5343
Mailing Address - Country:US
Mailing Address - Phone:630-325-1799
Mailing Address - Fax:630-325-1882
Practice Address - Street 1:621 PLAINFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILLOW BROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5343
Practice Address - Country:US
Practice Address - Phone:630-325-1799
Practice Address - Fax:630-325-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK31156Medicare PIN
ILK49503Medicare PIN
ILK49501Medicare PIN
ILK49502Medicare PIN