Healthcare Provider Details

I. General information

NPI: 1598786816
Provider Name (Legal Business Name): ZULIMA HURTADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 GRAND AVE
WAUKEGAN IL
60085-2321
US

IV. Provider business mailing address

3012 GRAND AVE
WAUKEGAN IL
60085-2321
US

V. Phone/Fax

Practice location:
  • Phone: 847-546-0080
  • Fax: 847-546-0083
Mailing address:
  • Phone: 847-546-0080
  • Fax: 847-546-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36090009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: