Healthcare Provider Details

I. General information

NPI: 1912954637
Provider Name (Legal Business Name): ANAS ALZOOBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 S RIDGEWOOD
PALOS PARK IL
60464
US

IV. Provider business mailing address

13011 S RIDGEWOOD
PALOS PARK IL
60464
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-5527
  • Fax:
Mailing address:
  • Phone: 708-361-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-3260
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036104479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: