Healthcare Provider Details

I. General information

NPI: 1497295992
Provider Name (Legal Business Name): ANDREW ZAPKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 N CLARENDON AVE
CHICAGO IL
60640-5122
US

IV. Provider business mailing address

4720 N CLARENDON AVE
CHICAGO IL
60640-5122
US

V. Phone/Fax

Practice location:
  • Phone: 773-313-4510
  • Fax:
Mailing address:
  • Phone: 773-313-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020080
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: