Healthcare Provider Details

I. General information

NPI: 1689897845
Provider Name (Legal Business Name): WILLIAM R ZIZIC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1905
CHICAGO IL
60602-1823
US

IV. Provider business mailing address

25 E WASHINGTON ST STE 1905
CHICAGO IL
60602-1823
US

V. Phone/Fax

Practice location:
  • Phone: 312-641-0002
  • Fax: 312-641-2258
Mailing address:
  • Phone: 312-641-0002
  • Fax: 312-641-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: