Healthcare Provider Details

I. General information

NPI: 1104375666
Provider Name (Legal Business Name): EXIST CHICAGO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 PARK ST STE 100
NAPERVILLE IL
60563-4863
US

IV. Provider business mailing address

4728 N PAULINA ST 3N
CHICAGO IL
60640-4431
US

V. Phone/Fax

Practice location:
  • Phone: 847-858-5212
  • Fax:
Mailing address:
  • Phone: 847-858-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071008088
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number071008088
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number071008088
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071008088
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008088
License Number StateIL

VIII. Authorized Official

Name: DR. CHRISTOPHER RAYMOND ZURAWIC
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 847-858-5212