Provider Demographics
NPI:1821005448
Name:ZAIDI, HASHIM RAZA (MD)
Entity Type:Individual
Prefix:MR
First Name:HASHIM
Middle Name:RAZA
Last Name:ZAIDI
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 1:555 W COURT ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3664
Mailing Address - Country:US
Mailing Address - Phone:815-802-8740
Mailing Address - Fax:
Practice Address - Street 1:692 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:HERSCHER
Practice Address - State:IL
Practice Address - Zip Code:60941-9785
Practice Address - Country:US
Practice Address - Phone:815-426-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-116487OtherSTATE LICENSE
ILBZ889443OtherDEA