Healthcare Provider Details

I. General information

NPI: 1578386694
Provider Name (Legal Business Name): KAYLE ZANFARDINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S HIGHLAND AVE STE 220
LOMBARD IL
60148-4932
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-2225
  • Fax: 630-873-8745
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-010917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: