Healthcare Provider Details

I. General information

NPI: 1699696674
Provider Name (Legal Business Name): MAZAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 GALITZ ST APT 1A
SKOKIE IL
60077-2739
US

IV. Provider business mailing address

610 LEAMINGTON AVE
WILMETTE IL
60091-2058
US

V. Phone/Fax

Practice location:
  • Phone: 945-403-2756
  • Fax: 945-403-2756
Mailing address:
  • Phone: 897-979-7980
  • Fax: 897-979-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAMAN K MASITI
Title or Position: PRESIDENT
Credential:
Phone: 897-979-7980