Healthcare Provider Details

I. General information

NPI: 1417833807
Provider Name (Legal Business Name): ZEEL AMIT KOTHARI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 20-100
CHICAGO IL
60611-5970
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 20-100
CHICAGO IL
60611-5970
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4360
  • Fax: 312-695-1435
Mailing address:
  • Phone: 312-695-4360
  • Fax: 312-695-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.032226
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: