Healthcare Provider Details

I. General information

NPI: 1285848622
Provider Name (Legal Business Name): VETA MARINA ZIKOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST DEPARTMENT OF EMERGENCY MEDICINE, SUITE 185W
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST DEPARTMENT OF EMERGENCY MEDICINE, SUITE 185W
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5375
  • Fax:
Mailing address:
  • Phone: 708-684-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.117211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: