Healthcare Provider Details

I. General information

NPI: 1780487629
Provider Name (Legal Business Name): SHIRIN ZOHAIB JIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8428 AUSTIN AVE
MORTON GROVE IL
60053-3212
US

IV. Provider business mailing address

8428 AUSTIN AVE
MORTON GROVE IL
60053-3212
US

V. Phone/Fax

Practice location:
  • Phone: 224-600-6007
  • Fax:
Mailing address:
  • Phone: 224-600-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: