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General NPI Number Information
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NPI Number | 1114249174
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Entity Type | Organization
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Legal Business Name | JEROME G ZWIERZYCKI MD SC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 420 LAKE COOK RD SUITE 106
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City | DEERFIELD
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State | IL
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Zip | 60015-5646
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Country | US
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Telephone | 847-444-0486
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Fax | 847-444-0487
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Provider Business Mailing Address
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Address Line | 420 LAKE COOK RD SUITE 106
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City | DEERFIELD
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State | IL
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Zip | 60015-5646
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Country | US
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Telephone | 847-444-0486
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Fax | 847-444-0487
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JEROME G ZWIERZYCKI
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Credential | MD
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Telephone | 847-444-0486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-071997
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License Number State | IL
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