Healthcare Provider Details

I. General information

NPI: 1568720753
Provider Name (Legal Business Name): JEFFREY BRIAN ZIFFRA JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HIGHLAND AVE STE 400
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 630-719-4799
  • Fax: 630-785-2128
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.145896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: