Healthcare Provider Details

I. General information

NPI: 1851387120
Provider Name (Legal Business Name): PHILLIP ZARET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W ROCKLAND RD
LIBERTYVILLE IL
60048-2700
US

IV. Provider business mailing address

114 W ROCKLAND RD
LIBERTYVILLE IL
60048-2700
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-8802
  • Fax: 847-316-7086
Mailing address:
  • Phone: 847-353-8802
  • Fax: 847-316-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036-060541
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-060541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: