Healthcare Provider Details

I. General information

NPI: 1427510676
Provider Name (Legal Business Name): LIRIDON ZENDELI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

IV. Provider business mailing address

540 N STATE ST APT 3909
CHICAGO IL
60654-7240
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-8000
  • Fax:
Mailing address:
  • Phone: 217-549-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number036171414
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1427510676
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036171414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: