Healthcare Provider Details

I. General information

NPI: 1588959530
Provider Name (Legal Business Name): PETER THOMAS ZAVISLAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

1650 W HARRISON ST SUITE 466
CHICAGO IL
60612-3800
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5495
  • Fax:
Mailing address:
  • Phone: 312-942-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01079931A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036135255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: