Provider Demographics
NPI:1548442940
Name:MOSHE ZAMIR, M.D. S.C.
Entity type:Organization
Organization Name:MOSHE ZAMIR, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, SC
Authorized Official - Phone:847-659-8283
Mailing Address - Street 1:12525 REGENCY PKWY, STE F
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6500
Mailing Address - Country:US
Mailing Address - Phone:847-659-8283
Mailing Address - Fax:847-659-8345
Practice Address - Street 1:12525 REGENCY PKWY, STE F
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6500
Practice Address - Country:US
Practice Address - Phone:847-659-8283
Practice Address - Fax:847-659-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052799302F00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C38311Medicare UPIN