Provider Demographics
NPI:1306836200
Name:INFECTIOUS DISEASE SPECIALISTS LTD.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKHIREH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-333-3113
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0729
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:16532 OAK PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1918
Practice Address - Country:US
Practice Address - Phone:708-333-3113
Practice Address - Fax:708-333-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCM7411OtherRR MEDICARE GROUP NUMBER
3160176976OtherBCBSIL GROUP NUMBER
ILCM7411OtherRR MEDICARE GROUP NUMBER
IL6247980001Medicare NSC
IL594180Medicare PIN
IL911220Medicare PIN