Provider Demographics
NPI:1841349511
Name:M AMIN ZAMAN MD SC
Entity type:Organization
Organization Name:M AMIN ZAMAN MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:ZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-667-7007
Mailing Address - Street 1:500 OHARA DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2316
Mailing Address - Country:US
Mailing Address - Phone:618-667-7007
Mailing Address - Fax:618-667-4260
Practice Address - Street 1:500 OHARA DR STE 120
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2316
Practice Address - Country:US
Practice Address - Phone:618-667-7007
Practice Address - Fax:618-667-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114379261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG23818Medicare UPIN