Healthcare Provider Details

I. General information

NPI: 1730250424
Provider Name (Legal Business Name): FUAD ZIAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
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

1 HAMPTON CT
BURR RIDGE IL
60527-5760
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5670
  • Fax: 708-684-4764
Mailing address:
  • Phone: 630-920-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number36048171
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: