Healthcare Provider Details

I. General information

NPI: 1306836200
Provider Name (Legal Business Name): INFECTIOUS DISEASE SPECIALISTS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16532 OAK PARK AVE SUITE 101
TINLEY PARK IL
60477-1918
US

IV. Provider business mailing address

PO BOX 729
MATTESON IL
60443-0729
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-3113
  • Fax: 708-333-8991
Mailing address:
  • Phone: 708-862-7674
  • Fax: 708-862-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BEHNAM ZAKHIREH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-333-3113