Provider Demographics
NPI:1679740435
Name:MAZHAR, SALIM A
Entity type:Individual
Prefix:
First Name:SALIM
Middle Name:A
Last Name:MAZHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5979
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-5979
Mailing Address - Country:US
Mailing Address - Phone:847-897-5995
Mailing Address - Fax:847-897-5990
Practice Address - Street 1:6300 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1702
Practice Address - Country:US
Practice Address - Phone:773-465-0040
Practice Address - Fax:773-465-0044
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist