Healthcare Provider Details

I. General information

NPI: 1417808023
Provider Name (Legal Business Name): ZAINAH AZAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 S 104TH AVE, ST. 100
PALOS PARK IL
60464-1506
US

IV. Provider business mailing address

13011 S 104TH AVE, ST. 100
PALOS PARK IL
60464-1506
US

V. Phone/Fax

Practice location:
  • Phone: 708-390-2030
  • Fax: 708-390-2130
Mailing address:
  • Phone: 708-390-2030
  • Fax: 708-390-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.012130
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: