Healthcare Provider Details

I. General information

NPI: 1083302624
Provider Name (Legal Business Name): ZAIN S TALUKDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KENNEDY DR STE 900
BRADLEY IL
60915-2683
US

IV. Provider business mailing address

400 S KENNEDY DR STE 900
BRADLEY IL
60915-2683
US

V. Phone/Fax

Practice location:
  • Phone: 815-936-8963
  • Fax: 815-937-7652
Mailing address:
  • Phone: 815-936-8963
  • Fax: 815-937-7652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036178817
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.081454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: