Basic Information
| Provider Information | |||||||||
| NPI: | 1780636944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMAN | ||||||||
| FirstName: | ASAD | ||||||||
| MiddleName: | U. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 167TH ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604772859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084293700 | ||||||||
| FaxNumber: | 7084294460 | ||||||||
| Practice Location | |||||||||
| Address1: | 6700 167TH ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604772859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084293700 | ||||||||
| FaxNumber: | 7084294460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 12/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-090371 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01622760 | 01 | IL | BLUE SHIELD NUMBER | OTHER | TAX ID | 01 | IL | 36-4295605 | OTHER | 036090371 | 05 | IL | MEDICAID |