Individual
ETANA ZACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Mailing address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036143859
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036143859
—
IL
Enumeration date
04/17/2014
Last updated
03/04/2020
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