MEDICARE: ZAKENN MEDICAL CENTER LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1508616889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZAKENN MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	240 WALTHAM ST
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5234
Country	:	US
Telephone Number	:	312-292-1986
Fax Number	:

Provider Business Practice Location Address
First Line	:	5732 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4152
Country	:	US
Telephone Number	:	312-292-1986
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	NNEKA OKAGBUE
Credential	:	APRN
Telephone Number	:	312-292-1986

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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Directions to “ZAKENN MEDICAL CENTER LLC ” Practice Location

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