Healthcare Provider Details

I. General information

NPI: 1699700872
Provider Name (Legal Business Name): GILBERTO ZAVALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUTIE 318
CHICAGO IL
60612
US

IV. Provider business mailing address

1725 W HARRISON ST STE 318
CHICAGO IL
60612-3817
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6647
  • Fax: 312-942-3740
Mailing address:
  • Phone: 312-942-6647
  • Fax: 312-942-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036103577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: