Healthcare Provider Details

I. General information

NPI: 1457591778
Provider Name (Legal Business Name): ZAPATA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3743 W FULLERTON AVE
CHICAGO IL
60647-2330
US

IV. Provider business mailing address

7107 W BELMONT AVE STE 5
CHICAGO IL
60634-4500
US

V. Phone/Fax

Practice location:
  • Phone: 773-698-7004
  • Fax: 773-698-7010
Mailing address:
  • Phone: 773-622-4400
  • Fax: 773-622-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN FERNANDO ZAPATA
Title or Position: DOCTOR
Credential: MD
Phone: 773-698-7004