Healthcare Provider Details

I. General information

NPI: 1740543958
Provider Name (Legal Business Name): JILL ZAVERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 S GREENLEAF ST
GURNEE IL
60031-3300
US

IV. Provider business mailing address

48 S GREENLEAF ST
GURNEE IL
60031-3300
US

V. Phone/Fax

Practice location:
  • Phone: 847-662-4016
  • Fax:
Mailing address:
  • Phone: 847-662-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-144105
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-144105
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: