Provider Demographics
NPI:1346432481
Name:ANWAR, ZAKI
Entity Type:Individual
Prefix:DR
First Name:ZAKI
Middle Name:
Last Name:ANWAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10181 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1274
Mailing Address - Country:US
Mailing Address - Phone:815-464-7212
Mailing Address - Fax:815-277-5509
Practice Address - Street 1:10181 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1274
Practice Address - Country:US
Practice Address - Phone:815-464-7212
Practice Address - Fax:815-277-5507
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090578208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-090578Medicaid
IL9932377OtherBLUE CROSS
ILP00025045OtherRR MEDICARE
ILP00025045OtherRR MEDICARE
IL036-090578Medicaid
IL214228Medicare PIN