Provider Demographics
NPI:1912017898
Name:HAIDER, SYED WASEEM (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:WASEEM
Last Name:HAIDER
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:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60039-2036
Mailing Address - Country:US
Mailing Address - Phone:815-788-0468
Mailing Address - Fax:815-788-0489
Practice Address - Street 1:650 DAKOTA ST STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3744
Practice Address - Country:US
Practice Address - Phone:815-455-6000
Practice Address - Fax:815-356-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100063Medicaid
IL208664Medicare ID - Type Unspecified
IL036100063Medicaid