Provider Demographics
NPI:1639178924
Name:ZAKHIREH, BEHNAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHNAM
Middle Name:
Last Name:ZAKHIREH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059003207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059003Medicaid
IL3160176976OtherBLUE SHIELD
IL3160176976OtherBLUE SHIELD
IL036059003Medicaid
ILL05025Medicare PIN
IL594180Medicare PIN
IL911220Medicare PIN
IL440001297Medicare PIN
IL440003102Medicare PIN
IL036059003Medicaid