Healthcare Provider Details

I. General information

NPI: 1790805778
Provider Name (Legal Business Name): ZARINA Z. BANDUKWALA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 N PAULINA ST
CHICAGO IL
60640-2772
US

IV. Provider business mailing address

1850 ELIZABETH CT
DEERFIELD IL
60015-2041
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-9040
  • Fax: 773-989-1516
Mailing address:
  • Phone: 847-236-0817
  • Fax: 847-236-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036062340
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036062340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: