Healthcare Provider Details

I. General information

NPI: 1093949240
Provider Name (Legal Business Name): TETIANA ZUBRYCKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2009
Last Update Date: 10/20/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST. HOSPITALIST OFFICE-ROOM 111W ST. MARY AND ELIZABETH MEDICAL CENTER
CHICAGO IL
60622
US

IV. Provider business mailing address

2233 W DIVISION ST. HOSPITALIST OFFICE-ROOM 111W ST. MARY AND ELIZABETH MEDICAL CENTER
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2128
  • Fax: 773-728-5134
Mailing address:
  • Phone: 312-770-2128
  • Fax: 773-728-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.122970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: