Basic Information
| Provider Information | |||||||||
| NPI: | 1578138350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHAJAN | ||||||||
| FirstName: | ZUBIN | ||||||||
| MiddleName: | AJAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | LOYOLA MEDICINE MACNEAL HOSPITAL 3249 SOUTH OAK PARK AV | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087833401 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MACNEAL CENTER FOR INTERNAL MEDICINE 3722 SOUTH HARLEM | ||||||||
| Address2: | SUITE LL34 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087836566 | ||||||||
| FaxNumber: | 7087836567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2021 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125-078082 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.