1508009416 NPI number — MISS ANCA IOANA ZEGREAN M.D.

Table of content: MISS ANCA IOANA ZEGREAN M.D. (NPI 1508009416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508009416 NPI number — MISS ANCA IOANA ZEGREAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEGREAN
Provider First Name:
ANCA
Provider Middle Name:
IOANA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508009416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 S DESPLAINES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60661-5500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-654-2720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1272 AMERICAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-549-7222
Provider Business Practice Location Address Fax Number:
847-549-7260
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25268 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RE9310001 . This is a "GROUP ORGANIZATION PTAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810026117 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295720449 . This is a "GROUP ORGANIZATION NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4000438000 . This is a "GROUP ORGANIZATION MEDICAID NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: WV2871A . This is a "MEDICARE PTAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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