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General NPI Number Information
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NPI Number | 1104076405
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Entity Type | Organization
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Legal Business Name | MERRILL J ZAHTZ MD SC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 8170 MCCORMICK BLVD SUITE 204
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City | SKOKIE
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State | IL
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Zip | 60076-2961
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Country | US
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Telephone | 773-621-6489
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Fax | 847-410-2041
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Provider Business Mailing Address
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Address Line | PO BOX 597130
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City | CHICAGO
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State | IL
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Zip | 60659-7130
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Country | US
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Telephone | 773-621-6489
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Fax | 847-410-2041
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. MERRILL ZAHTZ
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Credential | MD
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Telephone | 773-621-6489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0360563631
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License Number State | IL
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