| Fairview Ogden Medical Group | |
|
4121 Fairview Ave Suite # 100 Downers Grove IL 60515-2264 | |
| (630) 968-4790 | |
| (630) 968-8755 |
| Full Name | Fairview Ogden Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 4121 Fairview Ave, Downers Grove, Illinois |
| Authorized Official Name and Position | Zainulabuddin Syed (OWNER/PRESIDENT) |
| Authorized Official Contact | 6309684790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairview Ogden Medical Group 4121 Fairview Ave Suite # 100 Downers Grove IL 60515-2264 Ph: (630) 968-4790 | Fairview Ogden Medical Group 4121 Fairview Ave Suite # 100 Downers Grove IL 60515-2264 Ph: (630) 968-4790 |
| NPI Number | 1962683359 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 11/24/2010 |
| Medicare PECOS PAC ID | 2567658891 |
|---|---|
| Medicare Enrollment ID | O20101129000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962683359 | NPI | - | NPPES |
| 036091132 | Medicaid | IL | |
| 1609876424 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036-091132 (Illinois) | Primary |
| Provider Name | Zainulabuddin Syed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609876424 PECOS PAC ID: 7517963523 Enrollment ID: I20101129000142 |
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