Healthcare Provider Details

I. General information

NPI: 1154432532
Provider Name (Legal Business Name): CHESTER R ZEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E HURON ST
CHICAGO IL
60611-3004
US

IV. Provider business mailing address

2701 EASTWOOD AVE
EVANSTON IL
60201-1519
US

V. Phone/Fax

Practice location:
  • Phone: 312-649-3177
  • Fax:
Mailing address:
  • Phone: 847-475-2956
  • Fax: 847-474-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: