Zackariya, Khaleelur R

Zackariya, Khaleelur R is an individual health care provider with primary practice located at 5215 Holycross Parkway , Mishiwaka IN 46545. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is his primary health care specialty. Zackariya, Khaleelur R can be contacted via phone (574) 237-7168.

Contact Information

Primary practice address
5215 Holycross Parkway Mishiwaka IN 46545
Phone: (574) 237-7168
Fax: (574) 472-6262
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036098582 Illinois
Allopathic & Osteopathic Physicians / Addiction Medicine 207RA0401X 01066056A Indiana

Profile Details

NPI number 1306854203
LBN Legal business name Zackariya, Khaleelur R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 4th, 2006
Last updated Apr 19th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306854203 NPPES
Indiana MEDICAID 200930470

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