Healthcare Provider Details

I. General information

NPI: 1962663252
Provider Name (Legal Business Name): DEENA YAEL ZELTSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE DEPARTMENT OF PEDIATRICS
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

415 W FULLERTON PKWY APT 201
CHICAGO IL
60614-2859
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7979
  • Fax:
Mailing address:
  • Phone: 773-528-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036120364
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: