Healthcare Provider Details

I. General information

NPI: 1770018178
Provider Name (Legal Business Name): ZACHARY JOSEPH GRICE-PATIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

CAPTAIN JAMES A LOVELL FHCC GREEN BAY RD
NORTH CHICAGO IL
60064
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-7704
  • Fax:
Mailing address:
  • Phone: 224-610-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.163369
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.163369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: