Healthcare Provider Details

I. General information

NPI: 1407781701
Provider Name (Legal Business Name): CARLOS ZAMUDIO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22285 N PEPPER RD STE 409
LAKE BARRINGTON IL
60010-2542
US

IV. Provider business mailing address

22285 N PEPPER RD STE 409
LAKE BARRINGTON IL
60010-2542
US

V. Phone/Fax

Practice location:
  • Phone: 847-382-7165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number085011877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: