DR. KHALEELUR R ZACKARIYA SR. (NPI# 1306854203) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306854203 |
| Entity Type | Individual |
| Full Name | DR. KHALEELUR R ZACKARIYA SR. |
| Credential | MD |
| Practice Address |
5215 Holycross Parkway Mishiwaka IN 46545 |
| Mailing Address |
810 Park Pl Mishawaka IN 46545-3520 |
| Practice Telephone | 5742377168 |
| Practice Fax Number | 5744726262 |
| Mailing Telephone | 5744726901 |
| Mailing Fax Number | 5744726262 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2010-04-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 036098582 | IL | Allopathic & Osteopathic Physicians |
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
01066056A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200930470 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639126592 | Khaleelur Zackariya | Physical Therapist | 333 W Mishawaka Rd, Elkhart, IN 46517-1921 | 2006-05-27 |
| Street Address |
5215 HOLYCROSS PARKWAY |
| City | MISHIWAKA |
| State | IN |
| Zip Code | 46545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649824103 | Senior Helpers | In Home Supportive Care | 230 Catalpa Drive Suite B, Mishawaka, IN 46545 | 2019-08-01 |
| 1093272114 | Candice Marie Greathouse | Physical Therapy Assistant | 3630 Hickory Road, Mishawaka, IN 46545 | 2019-02-25 |
| 1639662596 | Mishawaka Rcf Lp | Assisted Living Facility | 3630 Hickory Rd, Mishawaka, IN 46545 | 2018-06-14 |
| 1760907299 | Timothy John Howard | Emergency Medicine | 610 1/2 N Main Street, Apartment 1, Mishawaka, IN 46545 | 2017-08-05 |
| 1699203612 | Paridhie Vasudevan | Dentist | 6502 Grape Rd Ste 882, Mishawaka, IN 46545 | 2017-06-03 |
| 1780134650 | Ossip Optometry, PC | Optometrist | 5111 N. Main Street, Suite 200, Mishawaka, IN 46545 | 2016-10-04 |
| 1457730038 | Melissa Anne Douthit | Nurse Practitioner | 3665 Park Pl W Ste 300, Mishawaka, IN 46545 | 2015-05-28 |
| 1558759654 | Spine and Joint Associates of Plymouth, Inc | Chiropractor | 229 Red Coach, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1609264795 | Spine and Joint Associates of Mishawaka, Inc | Chiropractor | 229 Red Coach Trail, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1508260795 | Maribel Smith | Counselor | 2989 Heritage Ct, Mishawaka, IN 46545 | 2014-10-16 |
| Find all providers in zip 46545 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457551103 | Medical Clinic of Greensburg | Internal Medicine | 203 East North Street, Greesnburg, IN 46240 | 2007-07-20 |
| 1215082813 | Steven E Stoller | Internal Medicine | 1528 Nw 5th St, Suite 100, Richmond, IN 47374-1844 | 2007-01-24 |
| 1265708168 | Shane Jacob Kibbe | Internal Medicine | 1220 Spring St, Jeffersonville, IN 47130-3704 | 2012-03-26 |
| 1104140664 | Adam Scott Lenet | Internal Medicine | 1481 W 10th St, Indianapolis, IN 46202-2803 | 2010-03-26 |
| 1215124474 | William E Washington Jr Md P C | Internal Medicine | 4844 Broadway, Gary, IN 46408-4509 | 2007-10-01 |
| 1053439489 | John Robert Colaluca | Internal Medicine | 898 E Main St, Greenwood, IN 46143-1407 | 2007-03-26 |
| 1740385525 | Rebecca H Kelly | Internal Medicine | 7250 Clearvista Dr, Suite 327a, Indianapolis, IN 46256-4692 | 2006-09-14 |
| 1619072493 | Fairbanks Hospital, Inc. | Internal Medicine | 8102 Clearvista Pkwy, Indianapolis, IN 46256-1661 | 2006-09-14 |
| 1730122268 | Michael Seth Miller | Internal Medicine | 8355 Rockville Rd Ste 120, Indianapolis, IN 46234-2722 | 2006-06-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.