Provider Demographics
NPI:1245294818
Name:ZAKIEH, NASSER (MD)
Entity type:Individual
Prefix:
First Name:NASSER
Middle Name:
Last Name:ZAKIEH
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 1:10604 SOUTHWEST HIGHWAY
Mailing Address - Street 2:STE 107
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2717
Mailing Address - Country:US
Mailing Address - Phone:708-422-0636
Mailing Address - Fax:708-424-2164
Practice Address - Street 1:10604 SOUTHWEST HIGHWAY
Practice Address - Street 2:STE 107
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2717
Practice Address - Country:US
Practice Address - Phone:708-422-0636
Practice Address - Fax:708-424-2164
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104388207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632457OtherBLUE CROSS BLUE SHIELD
IL036104388Medicaid
IL290014983OtherRAILROAD MEDICARE
ILF90378Medicare UPIN
IL036104388Medicaid