1467766436 NPI number — MS. CHRISTINE MARTINSON ZEIFERT OD

Table of content: MS. CHRISTINE MARTINSON ZEIFERT OD (NPI 1467766436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467766436 NPI number — MS. CHRISTINE MARTINSON ZEIFERT OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEIFERT
Provider First Name:
CHRISTINE
Provider Middle Name:
MARTINSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINSON
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467766436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1849 GREEN BAY RD
Provider Second Line Business Mailing Address:
STE 165
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-497-2020
Provider Business Mailing Address Fax Number:
847-497-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1849 GREEN BAY RD
Provider Second Line Business Practice Location Address:
STE 165
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-497-2020
Provider Business Practice Location Address Fax Number:
847-497-2002
Provider Enumeration Date:
08/02/2010

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: 152W00000X , with the licence number:  046010328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 046-010328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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