Healthcare Provider Details

I. General information

NPI: 1881924702
Provider Name (Legal Business Name): FAWWAD I ZAIDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 HALIGUS RD STE 120
HUNTLEY IL
60142-9526
US

IV. Provider business mailing address

10350 HALIGUS RD STE 120
HUNTLEY IL
60142-9526
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7480
  • Fax: 847-802-7485
Mailing address:
  • Phone: 847-802-7480
  • Fax: 847-802-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036128533
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036.128533
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036128533
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: