Healthcare Provider Details

I. General information

NPI: 1376643650
Provider Name (Legal Business Name): MARTHA ELLEN ZUEHLKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE SUITE 820
CHICAGO IL
60611-2826
US

IV. Provider business mailing address

842 FAIR OAKS AVE
OAK PARK IL
60302-1547
US

V. Phone/Fax

Practice location:
  • Phone: 312-988-7880
  • Fax: 708-386-8363
Mailing address:
  • Phone: 312-988-7880
  • Fax: 708-386-8363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036056657
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036056657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: