Healthcare Provider Details

I. General information

NPI: 1710307806
Provider Name (Legal Business Name): AMIR ZADAKA DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 W MELROSE ST # 1E
CHICAGO IL
60657-3751
US

IV. Provider business mailing address

531 W MELROSE ST # 1E
CHICAGO IL
60657-3751
US

V. Phone/Fax

Practice location:
  • Phone: 763-226-3239
  • Fax:
Mailing address:
  • Phone: 763-226-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95002501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: