Basic Information
| Provider Information | |||||||||
| NPI: | 1306836200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASE SPECIALISTS LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 729 | ||||||||
| Address2: | |||||||||
| City: | MATTESON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604430729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088627674 | ||||||||
| FaxNumber: | 7088621781 | ||||||||
| Practice Location | |||||||||
| Address1: | 16532 OAK PARK AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083333113 | ||||||||
| FaxNumber: | 7083338991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | ZAKHIREH | ||||||||
| AuthorizedOfficialFirstName: | BEHNAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7083333113 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | CM7411 | 01 | IL | RR MEDICARE GROUP NUMBER | OTHER | 3160176976 | 01 | BCBSIL GROUP NUMBER | OTHER |