Healthcare Provider Details

I. General information

NPI: 1093325763
Provider Name (Legal Business Name): ZAHRA MOSTAFA AL KHURIDAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF ILLINOIS HOSPITAL 1740 W. TAYLOR ST.
CHICAGO IL
60612
US

IV. Provider business mailing address

820 SOUTH WOOD STREET - UNIVERSITY OF ILLINOIS AT CHICA SUITE 100, MK 675, OFFICE OF GME
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-996-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.077045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: