Healthcare Provider Details

I. General information

NPI: 1013022565
Provider Name (Legal Business Name): DAVID ZICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE STE 1050
CHICAGO IL
60611-7019
US

IV. Provider business mailing address

737 N MICHIGAN AVE STE 1050
CHICAGO IL
60611-7019
US

V. Phone/Fax

Practice location:
  • Phone: 224-362-9424
  • Fax: 312-922-2503
Mailing address:
  • Phone: 224-362-9424
  • Fax: 312-922-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-104026
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036104026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: