Healthcare Provider Details

I. General information

NPI: 1861792715
Provider Name (Legal Business Name): FANG ZHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST RM 2510
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 W TAYLOR ST RM 2510
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-0235
  • Fax:
Mailing address:
  • Phone: 312-996-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036128372
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD60958890
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD60958890
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036128372
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60958890
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number036128372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: