Healthcare Provider Details

I. General information

NPI: 1770905804
Provider Name (Legal Business Name): ESAD ZISKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 W FARRAGUT AVE APT 3B
CHICAGO IL
60625-2477
US

IV. Provider business mailing address

2441 W FARRAGUT AVE APT 3B
CHICAGO IL
60625-2477
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-1342
  • Fax:
Mailing address:
  • Phone: 773-293-1342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000402
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number238000402
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: