Individual provider Active NPI

Fazlur R. Zahurullah, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Rockford, IL
National Provider Identifier
1720068695
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
036102836 Issued in IL
Practice address
3401 N Perryville Rd
Rockford, IL 61114-8011
Phone
(815) 971-2000
NPI assigned
Jan 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 036102836 IL Primary

Addresses

Primary practice location

3401 N Perryville Rd
Rockford, IL 61114-8011

Mailing address

3401 N Perryville Rd
Rockford, IL 61114-8011
Phone (815) 971-2000

Other practice location 1

215 E 1st St Ste 105
Dixon, IL 61021-3169
Phone (815) 285-5603

Other identifiers 1

IdentifierTypeStateIssuer
036102836MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060425000486 IL Practitioner - Otolaryngology 9133139900 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Michigan Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1253 N Alpine Rd
Sa Brookside Specialty Center
Rockford, IL 61107-2201
Phone (779) 696-9201

1401 E State St
Rockford, IL 61104-2315
Phone (815) 489-4400

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036102836ILMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Oct 25, 2024 Accepting new patients
Katherine Shaw Bethea Hospital CurrentSince Jul 17, 2023 Accepting new patients
KSB Medical Group, Inc. CurrentSince Apr 24, 2023 Accepting new patients
Rockford Health Physicians CurrentSince Apr 17, 2006 Accepting new patients
Swedishamerican Hospital CurrentSince Oct 25, 2024 Accepting new patients
Swedishamerican Hospital Current Accepting new patients
KSB Medical Group, Inc. CurrentSince Apr 24, 2023 Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients
Featherstone Clinic, S.C. Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

403 E 1st St
Dixon, IL 61021
Phone (815) 285-5629

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

215 E 1st St
Ste 105
Dixon, IL 61021
Phone (815) 285-5603

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

1253 N Alpine Rd
Rockford, IL 61107
Phone (779) 696-9201

698 Featherstone Rd
Rockford, IL 61107
Phone (815) 398-3277

3401 N Perryville Rd
Rockford, IL 61114

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1720068695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148011",
            "telephone_number": "815-971-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148011",
            "telephone_number": "815-971-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 E 1st St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Dixon",
            "state": "IL",
            "postal_code": "610213169",
            "country_code": "US",
            "telephone_number": "815-285-5603",
            "fax_number": "815-285-5813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZAHURULLAH",
        "first_name": "FAZLUR",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "IL",
            "license": "036102836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102836",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.