Healthcare Provider Details

I. General information

NPI: 1598704074
Provider Name (Legal Business Name): KARIN ZIESMANN FIEDLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W ADDISON ST SUITE 501
CHICAGO IL
60634-4401
US

IV. Provider business mailing address

5600 W ADDISON ST SUITE 501
CHICAGO IL
60634-4401
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-6906
  • Fax: 773-282-8301
Mailing address:
  • Phone: 773-282-6906
  • Fax: 773-282-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036100730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: