Healthcare Provider Details

I. General information

NPI: 1376163865
Provider Name (Legal Business Name): JACK ZHAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

IV. Provider business mailing address

2000 OGDEN AVE STE P050
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 630-499-7500
  • Fax: 630-898-3970
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036163438
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036163438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: