Individual
DR. KHALEELUR R ZACKARIYA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5215 HOLYCROSS PARKWAY, MISHIWAKA, IN 46545
(574) 237-7168
(574) 472-6262
Mailing address
810 PARK PL, MISHAWAKA, IN 46545-3520
(574) 472-6901
(574) 472-6262
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036098582
IL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
01066056A
IN
208M00000X
Hospitalist Physician
01066056A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200930470
—
IN
Enumeration date
08/04/2006
Last updated
10/30/2024
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