Healthcare Provider Details

I. General information

NPI: 1639529449
Provider Name (Legal Business Name): JAMILA ZAINULBHAI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

100 E 14TH ST APT 2804
CHICAGO IL
60605-3675
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.069377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: