MEDICARE: FATLIND ZHUTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	125060436	IL

General Provider Information

NPI Number	:	1205124617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATLIND ZHUTA M.D.

Provider Business Mailing Address
First Line	:	701 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3236
Country	:	US
Telephone Number	:	386-943-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 S KING DR
Second Line	:	APT 1101
City	:	CHICAGO
State	:	IL
Zip	:	60616-3343
Country	:	US
Telephone Number	:	312-860-3746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	04/19/2017

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