Healthcare Provider Details

I. General information

NPI: 1689169591
Provider Name (Legal Business Name): MICHAEL KERT ZIJLSTRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17850 KEDZIE AVE STE 3500
HAZEL CREST IL
60429-2082
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-957-4011
  • Fax: 708-957-4013
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.072046
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1689169591
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036155770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: