Provider Demographics
NPI:1790867356
Name:ZORUB CLINIC LTD
Entity Type:Organization
Organization Name:ZORUB CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSSAMA
Authorized Official - Middle Name:HOSNEY
Authorized Official - Last Name:ZORUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-9771
Mailing Address - Street 1:4700 W 95TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2533
Mailing Address - Country:US
Mailing Address - Phone:708-422-9771
Mailing Address - Fax:708-422-9024
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2533
Practice Address - Country:US
Practice Address - Phone:708-422-9771
Practice Address - Fax:708-422-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092465261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092465Medicaid
IL708210Medicare ID - Type Unspecified
IL036092465Medicaid