Healthcare Provider Details

I. General information

NPI: 1336452549
Provider Name (Legal Business Name): ELIZABETH ZULUAGA REINHARDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

IV. Provider business mailing address

1411 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

V. Phone/Fax

Practice location:
  • Phone: 312-454-2700
  • Fax: 312-544-1832
Mailing address:
  • Phone: 312-454-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036133112
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: