Provider Demographics
NPI:1912181744
Name:HOSAM ZAKARIYA M.D.,S.C.
Entity Type:Organization
Organization Name:HOSAM ZAKARIYA M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSAM
Authorized Official - Middle Name:YOUSIF
Authorized Official - Last Name:ZAKARIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-247-0560
Mailing Address - Street 1:755 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 181
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3253
Mailing Address - Country:US
Mailing Address - Phone:847-247-0560
Mailing Address - Fax:847-816-1262
Practice Address - Street 1:755 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 181
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3253
Practice Address - Country:US
Practice Address - Phone:847-247-0560
Practice Address - Fax:847-816-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL21228Medicare UPIN