Healthcare Provider Details

I. General information

NPI: 1205124617
Provider Name (Legal Business Name): FATLIND ZHUTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S KING DR APT 1101
CHICAGO IL
60616-3343
US

IV. Provider business mailing address

701 W PLYMOUTH AVE
DELAND FL
32720-3236
US

V. Phone/Fax

Practice location:
  • Phone: 312-860-3746
  • Fax:
Mailing address:
  • Phone: 386-943-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125060436
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: