Healthcare Provider Details

I. General information

NPI: 1174577340
Provider Name (Legal Business Name): LEONID ZETSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

2200 W HIGGINS RD STE 140
HOFFMAN ESTATES IL
60169-2422
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax: 773-293-4197
Mailing address:
  • Phone: 847-781-3100
  • Fax: 847-781-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036113804
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036113804
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036113804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: