1740275478 NPI number — MICHAEL ZDON M.D.

Table of content: MICHAEL ZDON M.D. (NPI 1740275478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740275478 NPI number — MICHAEL ZDON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZDON
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1740275478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 GREEN BAY RD
Provider Second Line Business Mailing Address:
CHICAGO MEDICAL SCHOOL
Provider Business Mailing Address City Name:
NORTH CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60064-3037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-578-8714
Provider Business Mailing Address Fax Number:
847-775-6504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 HOLLISTER DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064-5284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
947-918-9420
Provider Business Practice Location Address Fax Number:
847-918-9494
Provider Enumeration Date:
09/19/2005

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: 208600000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0102X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 36-077985 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com