Healthcare Provider Details

I. General information

NPI: 1003881699
Provider Name (Legal Business Name): KIRILL ZHADOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 N MILWAUKEE AVE SUITE 2-24
NILES IL
60714-3159
US

IV. Provider business mailing address

PO BOX 2056
NORTHBROOK IL
60065-2056
US

V. Phone/Fax

Practice location:
  • Phone: 847-825-0800
  • Fax: 847-825-0803
Mailing address:
  • Phone: 847-858-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036106200
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036-106200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: