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General NPI Number Information
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NPI Number | 1588959530
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Entity Type | Individual
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Provider Name | PETER THOMAS ZAVISLAK MD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 600 S PAULINA ST
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City | CHICAGO
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State | IL
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Zip | 60612-3806
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Country | US
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Telephone | 312-942-5495
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 W HARRISON ST SUITE 466
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City | CHICAGO
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State | IL
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Zip | 60612-3800
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Country | US
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Telephone | 312-942-5000
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01079931A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036135255
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License Number State | IL
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