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General NPI Number Information
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NPI Number | 1396446647
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Entity Type | Individual
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Provider Name | LEOR ZADAKA FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 250 E SUPERIOR ST STE 5-2322
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City | CHICAGO
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State | IL
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Zip | 60611-2914
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Country | US
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Telephone | 312-926-3411
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Fax | 312-926-8430
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Provider Business Mailing Address
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Address Line | 250 E SUPERIOR ST STE 5-2322
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City | CHICAGO
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State | IL
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Zip | 60611-2914
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Country | US
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Telephone | 312-926-3411
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Fax | 312-926-8430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.027047
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209027047
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License Number State | IL
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