Healthcare Provider Details

I. General information

NPI: 1861713232
Provider Name (Legal Business Name): DR. LENA ZARKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 111TH ST
CHICAGO IL
60628-4200
US

IV. Provider business mailing address

20 ASHTON DR
BURR RIDGE IL
60527-0305
US

V. Phone/Fax

Practice location:
  • Phone: 773-995-3000
  • Fax:
Mailing address:
  • Phone: 513-307-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019032436
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023183
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: