Healthcare Provider Details

I. General information

NPI: 1598939886
Provider Name (Legal Business Name): ZAFEER BERKI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIFFANY PT SUITE # 110
BLOOMINGDALE IL
60108-2936
US

IV. Provider business mailing address

PO BOX 597
LOCKPORT IL
60441-0597
US

V. Phone/Fax

Practice location:
  • Phone: 847-984-0585
  • Fax: 847-908-7564
Mailing address:
  • Phone: 847-984-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036094090
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number036094090
License Number StateIL

VIII. Authorized Official

Name: ZAFEER H. K. BERKI
Title or Position: PRESIDENT
Credential: MD
Phone: 847-984-0585