Healthcare Provider Details

I. General information

NPI: 1346506532
Provider Name (Legal Business Name): XIAOLONG ZHOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALAN ZHOU M.D.

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8106
  • Fax: 312-695-0537
Mailing address:
  • Phone: 312-695-8106
  • Fax: 312-695-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.140150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: