1760741938 NPI number — DR. DAVID ZACHARY OTHMAN M.D., M.H.S.A

Table of content: DR. DAVID ZACHARY OTHMAN M.D., M.H.S.A (NPI 1760741938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760741938 NPI number — DR. DAVID ZACHARY OTHMAN M.D., M.H.S.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTHMAN
Provider First Name:
DAVID
Provider Middle Name:
ZACHARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.H.S.A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OTHMAN
Provider Other First Name:
DAVID
Provider Other Middle Name:
ZACHARY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., M.H.S.A
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760741938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 N. HALSTED ST, SUITE 1
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:
60614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-600-5826
Provider Business Mailing Address Fax Number:
872-260-5008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 N HALSTED ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-600-5826
Provider Business Practice Location Address Fax Number:
872-260-5008
Provider Enumeration Date:
05/09/2012

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: 207N00000X , with the licence number:  036144735 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 143497 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X , with the licence number: 036144735 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X , with the licence number: 143497 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NP0225X , with the licence number: 036144735 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 143497 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 036144735 , 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: 024369500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036144735 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024369500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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