1588741805 NPI number — DR. MARIA P ZIPP M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588741805 NPI number — DR. MARIA P ZIPP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIPP
Provider First Name:
MARIA
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
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:
1588741805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 S WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-825-3030
Provider Business Mailing Address Fax Number:
847-518-8098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-825-3030
Provider Business Practice Location Address Fax Number:
847-518-8098
Provider Enumeration Date:
11/01/2006

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: 207R00000X , with the licence number:  036069111 , 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)

  • Identifier: 157871031904 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0004074954 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P507217-P507217A . This is a "OHI INC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: PR22340710001 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 31602057 . This is a "BCBS PROVIDER#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL9999 . This is a "MUTUAL OF OMAHA CO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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