Basic Information
| Provider Information | |||||||||
| NPI: | 1982667309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAKHDOOM | ||||||||
| FirstName: | ZAHOOR | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 365 | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629030365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185498006 | ||||||||
| FaxNumber: | 6185498434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 W DIANN LN | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629015339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185498006 | ||||||||
| FaxNumber: | 6185498434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 036094155 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 03926864 | 01 | IL | BCBS IL | OTHER | 036094155 | 01 | IL | BCBS | OTHER | 036698 | 01 | HEALTH ALLIANCE | OTHER | 036094155 | 05 | IL | MEDICAID | 435384 | 01 | HEALTHLINK | OTHER |