Provider Demographics
NPI:1437611761
Name:IFTEKARUDDIN, ZAID (MD)
Entity type:Individual
Prefix:
First Name:ZAID
Middle Name:
Last Name:IFTEKARUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E CHICAGO AVE UNIT 52B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6684
Mailing Address - Country:US
Mailing Address - Phone:312-864-3838
Mailing Address - Fax:312-864-9295
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:LL500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.073608207R00000X, 2085R0001X
IL036.1704402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine