Healthcare Provider Details

I. General information

NPI: 1134227259
Provider Name (Legal Business Name): CHARLES ZUGERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E DELAWARE PL STE 501
CHICAGO IL
60611-1666
US

IV. Provider business mailing address

201 E HURON ST STE 11-250
CHICAGO IL
60611-2968
US

V. Phone/Fax

Practice location:
  • Phone: 312-626-1759
  • Fax:
Mailing address:
  • Phone: 312-337-4020
  • Fax: 312-587-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number3650426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: