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General NPI Number Information
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NPI Number | 1093775405
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS GI SPECIALISTS LLC
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 1100 W DIANN LN
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City | CARBONDALE
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State | IL
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Zip | 62901-5339
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Country | US
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Telephone | 618-549-8006
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Fax | 618-549-8434
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | CARBONDALE
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State | IL
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Zip | 62903-0365
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Country | US
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Telephone | 618-476-9399
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Fax | 618-476-9547
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Authorized Official
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Title or Position | MD OWNER
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Name | ZAHOOR A MAKHDOOM
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Credential | MD
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Telephone | 618-549-8006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036094155
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License Number State | IL
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